Nocardiosis Flashcards
Clinical manifestations of Norcardiosis
pulmonary, cutaneous and CNS manifestations
caused by acid fast, aerobic filamentous branching Gram positive rod.
treatment of norcardiosis
depends on extent of infection
Bactrim (1st line), or minocycline is for isolated cutaneous infection.
Disseminated dx without CNS involvement need bactrim and amikacin, imipenem and amikacin, and 3rd generation cephaloporins
CNS dx without disseminated nocardia - bactrim with amikacin
disseminated dx with CNS needs all three.
Severe infections require combo medications.
pulmonary manifestations of Nocardiosis
fever, cough, dypsnea, hemoptysis, or chest pain
commonly disseminates from lungs to CNS
(esp in immunocompromised pts)
Cutaneous manifestations of Nocardiosis
Cutaneous- cellulitis, ulceration, abscess, lymphocutaneous lesions or mycetoma
CNS manifestations of nocardiosis
headache focal neurological deficits, seizures, meningismus
Nocardia and sepcial tropism to neural tissue and manifests as brain abscesses.
Anyone with immunocompromised status with pulmonary nocardiosis needs to get CNS imaging to rule out abscess.
Diagnosis of nocardiosis
Since not part of body at all, any isolation of this bacteria is sign of infection.
see partially acid fast aerobic filamentous branching Gram POSITIVE rod
lung imaging shows nodular infiltrates, consolidation or abscesses
CT head shows multiple parenchyma lesions/abscesses
where is nocardia found?
in soil and can enter the body through inhalation or direct contact with soil.
how long does aerobic cultures for Nocardia take to grow?
5-20 days
PCR for norcardia?
faster than culture and more accurate but make take some time to grow
Non severe cutaneous nocardiosis can be treated with
oral antibiotics - TMP-SMX and systemic dx requires IV antibiotics
immunocompromised pts need to have
lifelong suppressive therapy with bactrim or doxycycline if they have been infected once with nocardia
What is actinomyces?
anaerobic gram positive Rod that is part of normal oral flora. contains sulfur granules.
affects the face (after dental work and oromaxillary trauma) and abdominal organs
Doesn’t go to CNS or lungs (less commonly) the same way nocardia does
does toxoplasma gondii ever go to the lungs?
no it’s goes to the CNS and symptomatic in HIV pts. see multiple ring enhancing brain lesions and edema seen in the basal ganglia.
treatment of nocardiosis with cutaneous involvement only
depends on extent of infection
Bactrim (1st line), or minocycline is for isolated cutaneous infection.
treatment of nocardiosis with disseminated infection without CNS involvement
Disseminated dx without CNS involvement need bactrim and amikacin OR
imipenem and amikacin,
