Systemic nocardiosis is a rare infectious disease caused by soil-dwelling bacteria of the genus Nocardia. It affects the lungs or spreads throughout the body in people with weakened immune systems. Symptoms vary depending on the infected area but may include fever, cough, skin sores, confusion, and brain abscesses. Diagnosis involves imaging tests, biopsies, and cultures. Treatment requires long-term antibiotics like sulfamethoxazole-trimethoprim. Prevention efforts focus on avoiding direct skin contact with contaminated soil and prophylactic antibiotics for high-risk patients.

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SYSTEMIC NOCARDIOSIS
Systemic 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.
 The infection can be dangerous for people who have weak immune systemis result of anothermedical
condition such as cancer or HIV.
 It is most commonly in male than female.
 It causes diseases in humans and as well as cats,dogs,birds, fishes and cattle.
Etiology:
 The causative agents of systemic Nocardiosis are Nocardia asteroides , Nocardia brasiliensis , N- cancava,
N- africana and N- cornea.
 Nocardia asteroides , Nocardia brasiliens is are most common in systemic nocardiosis.
 That is normaly found in soil, water and can enters into the human body when a person inhales the
contaminated dust 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.
Epidemiology:
 Occur in worldwide .
 Earlier report estimate that incidence of nocardiosis in the united states at 500 to 1000 cases per year.
 In about 60% of theses cases the infection is related to a weak immune system.
International
 Rate of nocardiasis vary by country, for example in Japan 45 patients with cutaneous nocardiasis were
reported by 1985.
 Approximately 90% of those patients had mycetoma.
Mortality:
In patients with brain abscess the mortality rate is 80% and in other form the mortality is 50%.
Sex
The male to female ratio is 3 ratio 1 in all form of systemic nocardiasis.
Age
Nocardiasis occur in all ages but aged people and children susceptible to nocardiosis due to weak immune system.

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Risk factors:
 Risk factors are the following
 Cancer patients
 HIV AIDS
 Diabetes
 Chronic lung disease
 Bone marrow or organ transplantation
 The long term use of steroids medication
 Intravenous drug abusers.
Transmission:
 Respiratory tract is special route for pulmonary and systemic nocardiasis infection .
 Contact of wounds with contaminated soil or still water.
 In the jaw this leads to the entrance of Nocardia into the blood stream and causing systemic nocardiasis.
 Contaminated medial equipment's also transfer the nocardiasis.
Sign and Symptoms of Systemic Nocardiosis:
Entire Body Symptoms
 Recurring fever ( Fever occurring again and again)
 Malaise or Discomfort ( Feeling not good )
Lung Symptoms
 Breathing difficulty
 Cough
 Rapid breathing
 Chest pain which not related to any heart problems
 Shortness of breath
 Coughing up blood
Gastrointestinal System Symptoms:
 Nausea ( Feeling to like Vomiting )
 weight loss
 swelling of the liver and spleen
 Vomiting
Skin Symptoms
 Skin lumps or Rashes
 Abscessesorskin sores
 Swollen lymph nodes
Central Nervous System Nocardiosis:`
 Once the Nocardiosis spread through the bloodstream, it can cause a systemic Nocardiosis .
 When Nocardiosis infect the central nervous system(CNS) then it is known as CNS Nocardiosis.

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 CNS Nocardiosis occurs mostly in the Brain.
 Brain abscessesoccurs when a swollen area within brain tissue,containing an accumulation of pus.
 Death is more likely to occur in CNS nocardiosis.Antibiotic therapy needs immediately.
Central Nervous System Nocardiosis :
Brain Abscesses
 Pulmonary Nocardiosis is the usualcause of an abscess in the brain.
 CNS infection occurs in more than 40% of cases of Systemic Nocardiosis.
 Brain abscessestend to occurin those with weakened immune systems.
 The infection will cause your brain to swell from the collection of pus and dead cells that form Abscesses.
 Heart and lung infections are among the most common causes ofbrain abscesses.
 CNS Nocardiosis less common to occur than otherNocardiosis infections.
 But when it occurs in the brain, Death is more likely to occur in CNS nocardiosis than other Nocardiosis
infection .
 Antibiotic therapy needs immediately.
Sign and Symptoms of CNS Nocardiosis:
Nervous System Symptoms
 Confusion
 Headache
 Dizziness
 Seizures
 Changes in mental state
Muscle and Joint Symptoms
 Joint pain
Brain Symptoms
 Fever
 Seizures
 Headache
 Cerebral abscesses (a swollen area within brain tissue,containing an accumulation of pus)
How Is Systemic Nocardiosis Diagnosed
 A chest X-ray is an imaging test that produces detailed images of the lungs.
 A bronchoscopy is a test in which your doctoruses a thin tube with an attached camera to view the lungs.
 A brain biopsy is a procedure that involves removing a small sample of abnormal brain tissue.
 A lung biopsy is a procedure that involves removing a small sample of abnormal lung tissue.
 A skin biopsy is a procedure that involves removing a small sample of abnormal skin cells.
 A sputumculture is a procedure that involves taking a small sample of mucus
 CT (Computerized Tomography ) and MRI (Magnetic Resonance Imaging) scans can also be used to
diagnose a brain abscess.

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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.
 No Vaccination is available
Prevention:
 Prevention may be difficult in susceptible individuals.
 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.