Nocardiosisis an opportunistic infection more common in immune compromised hosts.
Disseminated nocardiosis has a poor outcome. We report a case of disseminated
nocardiosis with nocardaemia (case-1) which is an extremely rare finding even
in immune compromised subjects. In case-2 we found pulmonary abscess caused by
nocardia in a patient of sarcoidosis on steroids. Vascular thrombosis
complicating nocardiosis is not recognized. We report two cases of nocardiosis
with arterial thrombosis.
Nocardiaspecies are saprophytic aerobic actinomycetes and are common worldwide in soil
causing decay of organic matter. It is an opportunistic pathogen causing
significant morbidity and mortality in human beings. It predominantly affects
lung with pre-existing structural defects and also with co-existing
mycobacterial infection. Disseminated nocardiosis occurs through haematogenous
spread to distant organs including brain (commonest), bone, soft-tissues and
kidney; whereas peritoneum and heart valves only rarely affected. Isolating
nocardia in blood culture (nocardaemia) is extremely rare. Endovascular
foreign body e.g. prosthetic heart valve is a unique risk factor for
nocardaemia but our patient (case I) did not posses any such foreign body. Nocardia
bacteraemia is also associated with simultaneous infection with other bacterial
pathogens, especially Gram negative organisms in 30%. First patient had
concomitant Klebsiella infection [Extended-Spectrum Beta-Lactamase (ESBL)
producer in lung. Surprisingly in both the cases vascular thrombosis
complicated the picture-thrombosis in pulmonary trunk was in case- 1 and
lacunar infarcts of brain found in case-2. Nocardiosis and vascular thrombosis
may be causally related.
A
52 yr old gentleman presented to our clinic with fever and dry cough for 15
days. He also complained of chest tightness and exertional breathlessness for
the same duration. His fever was low grade, intermittent in nature and subsided
only on taking antipyretics. It was associated with cough without
expectoration, hemoptysis or chest pain.
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