Nocardia pneumonia

We discussed a case about an elderly woman with PMH of ESRD s/p renal transplant (within the year) on immunosuppressants & recent history of CMV colitis, who presented with acute fevers, malaise, cough, found to have Pulmonary Nocardia. We learned about:

Main risk factor: immunocompromised state

  • Patients on glucocorticoid therapy
  • Malignancy
  • Organ transplant recipients on immunosuppressant therapy
  • AIDS

Sites of infection: Pulmonary, CNS, cutaneous, disseminated

Definitive diagnosis: isolation & identification of the organism
Partially acid-fast w/ modified (Kinyoun stain)

Treatment: dependent on susceptibilities

  • 1st line: TMP-SMX
  • Alt: linezolid, clarithromycin, amikacin, cephalosporins, carbapenems
  • Duration: prolonged course depending on severity (e.g ~3-6 months vs 6-12+ months)

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