Pulmonary Nocardiosis: Review of Cases and an Update
Table 1
Details of patients with pulmonary nocardiosis.
Case
Case
Case
Case
Case
Age
76
70
57
70
42
Diagnosis
COPD with pulmonary T.B.
COPD with pulmonary T.B.
COPD with DM
Treated pulmonary T.B.
Treated pulmonary T.B.
H/o ATT
Yes
Yes
No
Yes
Yes
H/O DM
No
No
Yes
No
No
HIV
No
No
No
No
No
H/O smoking
Yes
Yes
Yes
No
No
COPD
Yes
Yes
Yes
No
No
Chief complaints
Breathlessness and increased cough with sputum for 4-5 days and loss of weight and loss of appetite
Breathlessness and cough with sputum for 20 years acutely increased for two weeks and fever for 1 week
Breathlessness and cough with sputum for 15 days
Breathlessness and cough with sputum for three months, intermittent fever for three months, and loss of weight
Persistent symptoms of fever, loss of appetite, and mucopurulent sputum for two months after ATT course
X-ray
Bilateral pneumonia
Bilateral pneumonia
—
Rt lower zone opacity
Left lower lobe collapse with consolidation
Clinical samples
Sputum
Sputum
Sputum
Sputum
BAL, BA, and sputum
SMEAR Grams
Gram positive branching filamentous rods with beads
Gram positive branching filamentous rods with beads
Gram positive branching filamentous rods with beads
Gram positive branching filamentous rods with beads
Gram positive branching filamentous rods with beads
Modified acid fast staining
Acid fast branching filamentous rods with beads
Acid fast branching filamentous rods with beads
Acid fast branching filamentous rods with beads
Acid fast branching filamentous rods with beads
Acid fast branching filamentous rods with beads
Culture on sheep blood agar
Positive after 48 hrs of incubation
Positive after 48 hrs of incubation
Culture-negative after seven days of incubation
Positive after three days of incubation
Positive after 48 hrs of incubation
Treatment
T. Septran 4 days Inj Amikacin 4 days Inj Imipenem 4 days
T. TMP-SMX 20 days Inj Amikacin 2 wks Inj Meropenem 10 days
T. TMP-SMX 5 days Inj Amikacin 5 days T. Voriconazole 5 days
Inj Amikacin 2 weeks T. TMP-SMX 4 months
Inj Amikacin 2 weeks T. TMP-SMX 4 months
Outcome
Patient expired after six days of admission
Discharged with advice to continue TMP-SMX for six months and to come for follow-up
Patient expired after six days of admission
Sputum negative after a week. Discharged with advice to continue TMP-SMX for six months and to come for follow-up
Sputum was negative after one wk of treatment. Discharged with advice to continue TMP-SMX for six mths and to come for follow-up
Follow-up
—
The patient was lost to follow-up
—
Sputum samples taken at one and two months of follow-up were negative. Complete resolution of the lesion at four months of treatment with TMP-SMX and no complaints
Smear-negative after seven days and after two weeks follow-up
