Clinical Syndromes - Nocardia

Clinical Syndromes

Clinical manifestations of disease caused by Nocardia depend on the site of infection. Nocardia causes following infections:

◗ Primary cutaneous nocardiosis

Primary cutaneous nocardiosis may manifest as cutaneous infection and lymphocutaneous infection. Cutaneous infec-tion may occur through wound contamination or by trauma. Usually feet and hands are involved.

Cutaneous infection: Actinomycotic mycetoma is the impor-tant lesion of cutaneous infection. Cutaneous infection may occur through wound contamination or by trauma. Usually feet and hands are involved. This condition is a painless chronic infection of the skin, characterized by subcutaneous swelling, suppuration, and presence of multiple sinuses. This is an invasive and destructive infection in which underlying bone and connective tissues are destroyed. As the infection progresses, multiple sinuses open to the surface of the skin with exudation or pus. The pus typically contains sulfur granules, which consist of filamentous Nocardia bound together by cal-cium phosphate.

Lymphocutaneous infection: The condition is characterizedby the presence of cutaneous nodules and ulcers associated with lymphadenopathy. The lymphadenopathy also may occasionally drain purulent pus.

◗ Bronchopulmonary infection

Bronchopulmonary infection is one of the important clinical manifestations in most patients with nocardiosis. Presence of inflammatory endobronchial masses, localized or generalized abscesses are the manifestations of the condition. The condition is associated with formation of cavities, abscesses in the lungs, and pleural effusion. Cough with production of sputum and fever are the common symptoms. Clinically, this condition can-not be distinguished from infections of other microbial etiology.

◗ Secondary CNS infection

The condition manifests as chronic meningitis or as manifesta-tion of single or multiple abscesses in the brain. CNS nocardiosis presents as slow, progressing mass lesion and is found in 20–40% of disseminated nocardial infection.