Pediatric Nocardiosis Follow-up

Updated: Oct 04, 2013
  • Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; Chief Editor: Russell W Steele, MD  more...
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Follow-up

Further Outpatient Care

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  • Once patient is stable, continue prolonged antibiotic therapy on an outpatient basis.
  • An infectious diseases specialist should continue to monitor the patient to determine treatment progress and duration.
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Further Inpatient Care

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  • Fulminant or disseminated nocardiosis requires multidisciplinary intensive-care management.
  • Provide ongoing assessment for surgical debridement of nocardial abscesses.
  • Initiate intravenous antibiotic therapy immediately, during inpatient admission.
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Transfer

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  • In cases of fulminant disseminated nocardiosis, transfer patient to a facility with pediatric intensive care and subspecialty care.
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Deterrence/Prevention

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  • No specific recommendations for prophylaxis against Nocardia as an opportunistic pathogen in patients with immunocompromising conditions are known.
  • Bactrim prophylaxis is recommended for patients with AIDS, chronic granulomatous disease, and various malignancies but is usually used in the context of preventing Pneumocystis pneumonia.
  • The use of prophylaxis should not preclude testing, if the situation warrants, attenuate the symptoms and signs of infection. Case reports of drug-resistant Nocardia presenting in Bactrim-prophylaxed immunosuppressed patients have been presented.
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Prognosis

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  • Morbidity and mortality are high from fulminant nocardiosis. A high index of suspicion, followed by a rapid diagnosis and treatment, is warranted.
  • Intensive medical management (surgery, if necessary) and prolonged treatment leads to a cure.
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