Micro - Nocardia Flashcards

1
Q

Nocardia is: (G+,G-), (anerobe, aerobe) (shape)

A

G+ aerobe with beaded, branching structure

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2
Q

Where is nocardia found?

A

Soil and water; it’s saprophytic = feeds on dead organisms

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3
Q

How do people get infected with nocardia?

A

Mainly through inhalation; cutaneously via contaminated soil

NOT spread person-person and isn’t nosocomial

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4
Q

Nocardia belongs to what group? Family?

A

Aerobic actinomycetes

Mycobacterium

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5
Q

What’s unique about nocardia cell wall?

A

Contains short chain mycolic acid, so it’s weakly staining

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6
Q

Most frequent form of nocardia found?

A

Nocardia asteroides complex

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7
Q

2 nocardia virulence factors?

A
  1. Superoxide dismutase/catalase

2. Cord factor

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8
Q

How do superoxide dismutase and catalase contribute to virulence of nocardia?

A

Inactive ROS so reduce toxic effects of PMNs and macropahges

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9
Q

How does cord factor contribute to virulence of nocardia?

A

Cord factor (dimycolic acid) prevents phagosome-lysosome fusion

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10
Q

What kind of patients get nocardia infections?

A

Immunocompromised = chronic lung disease, AIDS, DM, malignancy, transplant

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11
Q

The most common predisposing factor to nocardia infection is ____, making ____ disease the most common presentation of nocardia infection

A

Chronic lung infection

Pulmonary

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12
Q

When would a healthy host get a nocardia infection?

A

Skin wound comes in contact with contaminated soil –> soft tissue inoculation

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13
Q

Dissemination of nocardia often causes:

A
Bacteremia
Brain abscess
Empyema
Synovitis
Soft tissue infection
Pericarditis
Peritonitis
Corneal ulcers
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14
Q

Progression of nocardia infection

A

Acute inflammation –> necrosis and abscess

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15
Q

Sx of pulmonary nocardia infection

A
Hemoptysis
Fever
Night sweats
Chills
CP on inspiration
Weight loss
(mimics TB)
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16
Q

Sx of cerebral nocardia infection

A
Seizures
Confusion
HA
Lethargy
Dissipating neurological function
17
Q

Sx of cutaneous nocardia infection

A

Ulcer

If chronic, formation of draining tracts

18
Q

How to diagnose nocardia

A

Smear
Isolation
Gram stain/AFB stain of sputum sample

19
Q

Caveat of AFB staining for nocardia

A

Only used to confirm acid-fastness, not for initial identification

20
Q

How do you isolate nocardia?

A

Plate sputum/lavage sample on medium with yeast extract and activated charcoal (BCYE)

21
Q

Nocardia resistant to:

A

Tobramycin, erythromycin

22
Q

How to tx nocardia

A

SULFA!!!

23
Q

Tx nocardia infection in immunocompetent vs. immunocompromised pt

A

Immunocompetent = 6 months Immunocompromised = 12 months

24
Q

How to treat difficult nocardia infection?

A

Sulfa + amikacin + ceftriaxone