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Pulmonary nocardiosis

Nocardiosis - pulmonary; Mycetoma; Nocardia

Pulmonary nocardiosis is an infection of the lung with Nocardia bacteria.

Causes

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 with a weak immune system are at a high risk for nocardia infection. 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
  • HIV/AIDS
  • Lymphoma (a type of cancer)

Other people at risk include those with long-term (chronic) lung problems related to smoking, emphysema, or tuberculosis.

Symptoms

Pulmonary nocardiosis mainly affects the lungs. But, nocardiosis can also spread to other organs in the body. Common symptoms may include:

ENTIRE BODY

GASTROINTESTINAL SYSTEM

  • Nausea
  • Liver and spleen swelling (hepatosplenomegaly)
  • Loss of appetite
  • Unintentional weight loss
  • Vomiting

LUNGS AND AIRWAYS

  • Breathing difficulty
  • Chest pain not due to heart problems
  • Coughing up blood or mucus
  • Rapid breathing
  • Shortness of breath

MUSCLES AND JOINTS

NERVOUS SYSTEM

  • Change in mental state
  • Confusion
  • Dizziness
  • Headache
  • Seizures
  • Changes in vision

SKIN

  • Skin rashes or lumps
  • Skin sores (abscesses)
  • Swollen lymph nodes

Exams and Tests

Your health care provider 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:

Treatment

The goal of treatment is to control the infection. Antibiotics are used, but it may take a while to get better. Your provider will tell you how long you need to take the medicines. This may be for up to a year.

Surgery may be needed to remove or drain infected areas.

Your provider may tell you to stop taking any medicines that weaken your immune system. Never stop taking any medicine before talking to your provider first.

Outlook (Prognosis)

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.
  • The person has a serious disease that leads to or requires long-term suppression of the immune system.

Possible Complications

Complications of pulmonary nocardiosis may include:

When to Contact a Medical Professional

Contact your provider if you have symptoms of this disorder. Early diagnosis and treatment may improve the chance of a good outcome.

Prevention

Be careful when using corticosteroids. Use these medicines sparingly, in the lowest effective doses and for the shortest periods of time possible.

Some people with a weak immune system may need to take antibiotics for long periods of time or indefinitely to prevent the infection from returning.

Open References

References

Dockrell DH, Ho A, Gordon SB. Community-acquired pneumonia. In: Broaddus VC, Ernst JD, King Jr TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 46.

Southwick FS. Nocardiosis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 314. 

  • Respiratory system

    Respiratory system - illustration

    Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.

    Respiratory system

    illustration

  • Respiratory system

    Respiratory system - illustration

    Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.

    Respiratory system

    illustration

St. Luke’s, 915 East First Street, Duluth, MN 55805 218.249.5555 | 800.321.3790

Review Date: 7/31/2022

Reviewed By: Denis Hadjiliadis, MD, MHS, Paul F. Harron Jr. Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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