Nocardiosis It is a rare infectious disorder which affects the lungs or the entire body means it become systemic and causes disease in different parts of the body. Such as lungs, CNS, GIT, skin, heart, kidneys, eyes, muscles and joints infections. Bacterium from the genus Nocardia, especially Nocardia asteroides and Nocardia brasiliensis, is mainly responsible for the occurrence of this condition. Individuals with a weakened immunity due to some health problem are more at risk of developing this bacterial infection. It causes diseases in humans and as well as cats, dogs, birds, fishes and cattle.

1. l
SYSTEMIC
NOCARDIOSIS 1

2. Nocardiosis
• It is a rare infectious disorder which affects the lungs or the
entire body means it become systemic and causes disease in
different parts of the body.
• Such as lungs, CNS, GIT, skin, heart, kidneys, eyes, muscles
and joints infections.
• Bacterium from the genus Nocardia, especially Nocardia
asteroides and Nocardia brasiliensis, is mainly responsible
for the occurrence of this condition.
• Individuals with a weakened immunity due to some health
problem are more at risk of developing this bacterial
infection.
• It causes diseases in humans and as well as cats, dogs, birds,
fishes and cattle.

3. Etiology
• The causative agents of systemic Nocardiosis are Nocardia
asteroides or Nocardia brasiliensis.
• Theses are found in soil and enters the human body mainly
through breathing.
• The bacteria initially lead to pneumonia, which may cause
sepsis or blood poisoning.
• In this way, the infection may gradually spread to other
areas of the body such as skin and brain.
• The condition is referred to as disseminated Nocardiosis
when it occurs in this manner.

4. Epidemiology
• United States
• According to the Infectious Disease Society of America,
500-1000 patients with nocardiosis present
annually.[5] Many sources report that skin is primarily
involved in 5-7% of these infections
• International
• Rates of nocardiosis vary by country. For example, in Japan,
45 patients with cutaneous nocardiosis were reported by
1985. Approximately 90% of those patients had mycetoma
• Mortality/Morbidity
• Nocardiosis is primarily related to geographic distribution
rather than ethnicity and is more common in Mexican and
South American populations.
Dr.T.V.Rao MD 4

5. • Sex
• The male-to-female ratio is 3:1 in all forms of nocardiosis. The
predominance of men performing outdoor labor, rather than an
inherent predisposition, may be responsible for this ratio. The
lymphocutaneous or sporotrichoid form has a greater than 80%
male predominance.
• Age
• Primary cutaneous nocardiosis may occur in persons from any age
group but is more common in middle-aged adults, especially men.
Cervicofacial nocardiosis is a subgroup of the lymphocutaneous
type that affects children and is clinically distinguishable because it
occurs in children, manifesting as facial pustules or papules with
associated cervical or submandibular lymphadenopathy and fever
without a history of trauma.
Dr.T.V.Rao MD 5

6. Risk facotrs
-Alcoholism
-Diabetes
-Lymphoma
-Transplantation
-AIDS CD4+ < 250
Dr.T.V.Rao MD 6

7. Transmission
• The usual mode of transmission is inhalation of
organisms suspended in dust.
• Another very common method is that by
traumatic introduction, especially in the jaw. This
leads to the entrance of Nocardia into the blood
stream and the propagation of its pathogenic
effects. Transmission by direct inoculation
through puncture wounds or abrasions is less
common.Generally, nocardial infection requires
some degree of immune suppression.
Dr.T.V.Rao MD 7

8. Sign and Symptoms of Systemic
Nocardiosis
Entire Body Symptoms
• Recurring fever ( Fever occurring again and again)
• Malaise or Discomfort
Lung Symptoms
• Breathing difficulty
• Cough
• Rapid breathing
• Chest pain which not related to any heart problems
• Shortness of breath
• Coughing up blood
Dr.T.V.Rao MD 8

9. Sign and Symptoms of Systemic
Nocardiosis Continued….
Gastrointestinal System Symptoms
• Nausea ( Feeling to like Vomiting )
• weight loss
• swelling of the liver and spleen
• Vomiting
Dr.T.V.Rao MD 9
Skin lumps

10. Sign and Symptoms of Systemic
Nocardiosis Continued….
• Skin Symptoms
Skin lumps or Rashes
Abscesses or skin sores
Swollen lymph nodes
Dr.T.V.Rao MD 10

11. Central Nervous System Nocardiosis
Once the infection spread through the
bloodstream, it can cause a systemic infection
(disseminated form) and reach any organ in the
body. It can infect the central nervous system
(CNS) and particularly the brain leading to
cerebral nocardiosis or CNS nocardiosis. Abscess
formation in the CNS tissue is slow and
depending on the site of the mass, there may be
variations in the symptoms. Death is more likely
to occur in CNS nocardiosis. Antibiotic therapy
needs to be instituted immediately.
Dr.T.V.Rao MD 11

12. Brain Abscesses
• Bacterial infection is the usual cause of an abscess in the brain.
• brain abscesses tend to occur in those with weakened immune
systems.
• The infection will cause your brain to swell from the collection of
pus and dead cells that form.
• A brain abscess forms bacteria reach your brain through a wound in
your head or an infection somewhere else in your body. According
to the Children’s Hospital of Wisconsin, infections from other parts
of the body account for between 20 and 50 percent of all brain
abscess cases. Heart and lung infections are among the most
common causes of brain abscesses. Death is more likely to occur in
CNS nocardiosis. Antibiotic therapy needs immediately.
Dr.T.V.Rao MD 12

13. Sign and Symptoms of Systemic
Nocardiosis Continued….
• Nervous System Symptoms
• Confusion
• Headache
• Dizziness
• Seizures
• Changes in mental state
• Muscle and Joint Symptoms
• Joint pain
Dr.T.V.Rao MD 13

14. Sign and Symptoms of Systemic
Nocardiosis continued……
• Brain Symptoms
• Fever
• Seizures
• Headache
• Cerebral abscesses ( a swollen area within
brain tissue, containing an accumulation of
pus)
Dr.T.V.Rao MD 14

15. How Is Systemic Nocardiosis Diagnosed
 Samples of abscesses, skin, tracheobronchial lavage fluid, milk,
aspirates, organs.
 Culturing on Sabouraud agar:
• Incubate aerobically for 2 days at 37°C.
• Circular, convex, smooth or rough, firmly adherent to agar surface,
odorless, with various carotenoid-like pigments (cream, white,
orange, pink, or red), and present aerial hyphae and typical
powdery and dry surface, like fungal organisms.
 Stainning & Microscopy:
• acid-fast organisms.
• Gram-positive, filamentous,fragmented.
 Postmortem examination reveals…..abscesses and numerous
nodules….white to gray color.
 Histologic finding;
• Suppurative lesions……containing filamentous organisms
surrounded by macrophages, lymphocytes, and plasma cells.
Dr.T.V.Rao MD 15

16. How Systemic Nocardiosis Treated?
• All cases of nocardiosis should be treated with
long-term and low-dose antibiotics known as
sulfonamides. Treatment typically lasts from six
months to a year. However, more severe
infections may require treatment for a longer
period.
• Penicillin is not used in this treatment as
the Nocardia bacteria are penicillin-resistant.
Sulfamethoxazole-trimethoprim (Bactrim) is most
commonly used for treating Nocardiosis.
Dr.T.V.Rao MD 16

17. Prevention
• There is no vaccine currently available. The administration
of sulfonamide, ceftriaxone, and amikacin demonstrates
efficacy against difficult and unresponsive infections.
• Prevention may be difficult in susceptible individuals.
However, taking some preventive measures can decrease
their risk of developing the disease. They should avoid
working outdoors without protection. Wearing gloves and
socks can prevent the skin from coming into direct contact
with the soil. This measure should also be adopted by
healthy individuals to avoid the disorder.
• Taking Trimethoprim or sulfamethoxazole prophylaxis
during the first six months after undergoing organ
transplantation can help to prevent the condition.
Dr.T.V.Rao MD 17