Pulmonary nocardiosisNocardiosis - pulmonary
Pulmonary nocardiosis is an infection of the lung with the bacteria, Nocardia asteroides.
Nocardia infection develops when you breathe in (inhale) the bacteria. The infection causes pneumonia-like symptoms. The infection can spread to any part of the body.
People at highest risk for nocardia infection are those with a weakened immune system. This includes people who have:
- Been taking steroids or other medicines that weaken the immune system for a long time
- Cushing disease
- An organ transplant
Other people at risk include those with chronic lung problems related to smoking, emphysema, or other infections such as tuberculosis.
- Liver and spleen swelling (hepatosplenomegaly)
- Unintentional weight loss
Lungs and airways:
- Breathing difficulty
- Chest pain not due to heart problems
- Coughing up blood
- Cough with mucus
- Rapid breathing
- Shortness of breath
Muscles and joints:
- Change in mental state
- Skin rashes or lumps
- Skin sores (abscesses)
- Swollen lymph nodes
Exams and Tests
Your doctor or nurse will examine you and listen to your lungs using a stethoscope. You may have abnormal lung sounds, called crackles. Tests that may be done include:
- Bronchoalveolar lavage - fluid is sent for stain and culture, which is taken by bronchoscopy
- Chest x-ray
- CT scan of the chest
- Pleural fluid culture and stain
- Sputum stain and culture
The goal of treatment is to control the infection. Antibiotics are used, but it may take a while to get better. You must keep taking the medications for at least 3 months.
Surgery may be needed to remove or drain infected areas.
Your health care provider may tell you to stop taking any medicines that weaken your immune system. Never stop taking any medicine before talking to your health provider first.
The outcome is often good when the condition is diagnosed and treated quickly.
The outcome is poor when the infection spreads outside the lung, treatment is delayed, or the person has a serious disease that leads to or requires long-term suppression of the immune system.
- Brain abscesses
- Skin infections
When to Contact a Medical Professional
Call your health care provider if you have symptoms of this disorder. Early diagnosis and treatment may improve the chance of a good outcome.
Be careful when using corticosteroids. Use these drugs sparingly, in the lowest effective doses and for the shortest periods of time possible.
Some patients with an impaired immune system may need to take antibiotics for long periods of time to prevent the infection from returning.
Limper AH. Overview of pneumonia. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 97.
Torres A. Pyogenic bacterial pneumonia and lung abscess. In: Mason RJ, Broaddus CV, Martin TR, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 32.
Review Date: 8/25/2014
Reviewed By: Denis Hadjiliadis, MD, Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.