Nocardia - Revision history

Aidan at 22:05, 12 March 2023

2023-03-12T22:05:00Z

← Older revision		Revision as of 22:05, 12 March 2023
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	*Microscopic appearance similar to [[Actinomyces]], differentiated by acid fast staining ([[Actinomyces]] is ''not'' acid fast)		*Microscopic appearance similar to [[Actinomyces]], differentiated by acid fast staining ([[Actinomyces]] is ''not'' acid fast)
	*Colonies are slow to grow and have a chalky white appearance		*Colonies are slow to grow and have a chalky white appearance
	*~~Saprophyte~~ found in soil and water		*Ubiquitous environmental saprophyte found in soil and water

	=== Pathophysiology ===		=== Pathophysiology ===
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	* Spores or mycelia are either inhaled into the lungs or directly inoculated in the skin and soft tissue		* Spores or mycelia are either inhaled into the lungs or directly inoculated in the skin and soft tissue
	* Traumatic inoculation includes during motor vehicle collisions, mild scratches or pricks, or nosocomial with dirt entering through an open wound or central line		* Traumatic inoculation includes during motor vehicle collisions, mild scratches or pricks, or nosocomial with dirt entering through an open wound or central line
			* Forms difficult-to-treat biofilms when involved in [[CLABSI\|CLABSIs]]

	=== Risk Factors ===		=== Risk Factors ===
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	* Among transplant recipients, [[lung transplant]] appears to be highest risk		* Among transplant recipients, [[lung transplant]] appears to be highest risk
	* High-dose steroids and high levels of [[calcineurin inhibitors]] appear to be specific risk factors		* High-dose steroids and high levels of [[calcineurin inhibitors]] appear to be specific risk factors
			* Also diabetes and alcohol use

	== Clinical Manifestations ==		== Clinical Manifestations ==
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	==Management==		==Management==

			=== Further Evaluation ===

			* Consider screening MRI brain in all patients with disseminated or pulmonary disease regardless of neurologic symptoms
			* Consider CT chest in all patients
			* Consider assessment for immunodeficiency; at the very least, HIV testing and a good history

			=== Antimicrobial Selection ===
	*Mild to moderate: [[Is treated by::TMP-SMX]]		*Mild to moderate: [[Is treated by::TMP-SMX]]
	**Immunocompetent: 5-10 mg/kg split tid to qid		**Immunocompetent: 5-10 mg/kg split tid to qid

Aidan at 17:22, 10 March 2023

2023-03-10T17:22:30Z

← Older revision		Revision as of 17:22, 10 March 2023
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	* Usually starts with a focal infection (skin or lung), which then disseminates hematogenously		* Usually starts with a focal infection (skin or lung), which then disseminates hematogenously
	* Most commonly involves skin, lungs, and CNS, but can also ~~dissemiante~~ to kidney, joint, retina, and heart		* Most commonly involves skin, lungs, and CNS, but can also disseminate to kidney, joint, retina, and heart
	* Much more common in immunosuppressed patients		* Much more common in immunosuppressed patients

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	* Most common site of hematogenous dissemination		* Most common site of hematogenous dissemination
	* Presents with typical symptoms of fever, headache, meningismus, ~~seizures~~, and focal neurologic deficits		* Presents with typical symptoms of fever, headache, meningismus, seizure, and focal neurologic deficits
	* Can also be asymptomatic, so immunocompromised patients should get imaging and possibly LP		* Can also be asymptomatic, so immunocompromised patients should get imaging and possibly LP

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	* [[Mycetoma]]		* [[Mycetoma]]
	* Bacteremia		* [[Bacteremia]]
	* Ocular infection, either from direct inoculation or hematogenous spread		* Ocular infection, either from direct inoculation or hematogenous spread
	* Bone and joint infection, primarily from dissemination		* Bone and joint infection, primarily from dissemination
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	* Any non-cutaneous disease in immunocompromised host: at least 12 months, and possibly lifelong suppression		* Any non-cutaneous disease in immunocompromised host: at least 12 months, and possibly lifelong suppression

			=== Monitoring ===
⚫	{{DISPLAYTITLE:''Nocardia''}}

			* Serial CT scans to assess response to therapy
		⚫	* Monitoring for antibiotic toxicity{{DISPLAYTITLE:''Nocardia''}}
	[[Category:Gram-positive bacilli]]		[[Category:Gram-positive bacilli]]

Aidan: /* Risk Factors */

2023-01-23T21:50:58Z

Risk Factors

← Older revision		Revision as of 21:50, 23 January 2023
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	=== Risk Factors ===		=== Risk Factors ===

	* More common in immunocompromised (cell-mediated immunodeficiency including HIV, hematologic malignancy, and transplant patients), though can also occur in immunocompetent who have [[COPD]], [[bronchiectasis]], and [[cystic fibrosis]]		* More common in immunocompromised (cell-mediated immunodeficiency including [[HIV]], hematologic malignancy, and transplant patients), though can also occur in immunocompetent who have [[COPD]], [[bronchiectasis]], and [[cystic fibrosis]]
	* Among transplant recipients, lung transplant appears to be highest risk		* Among transplant recipients, [[lung transplant]] appears to be highest risk
	* High-dose steroids and high levels of ~~celcineurin~~ inhibitors appear to be specific risk factors		* High-dose steroids and high levels of [[calcineurin inhibitors]] appear to be specific risk factors

	== Clinical Manifestations ==		== Clinical Manifestations ==

Aidan at 12:53, 5 November 2022

2022-11-05T12:53:04Z

@@ Line 3: / Line 3: @@
 ===Microbiology===
-*Beaded [[Stain::Gram-positive]] [[Stain::partially acid-fast]] [[Shape::bacillus]]
+*Beaded [[Stain::Gram-positive]] [[Stain::partially acid-fast]] [[Shape::bacillus]] within the class [[Class::Actinobacteria]] and order [[Order::Corynebacteriales]]
 ==Management==

Aidan: Aidan moved page Nocardia species to Nocardia over a redirect without leaving a redirect

2022-01-25T16:55:34Z

Aidan moved page Nocardia species to Nocardia over a redirect without leaving a redirect

← Older revision	Revision as of 16:55, 25 January 2022
(No difference)

Aidan at 16:55, 25 January 2022

2022-01-25T16:55:27Z

@@ Line 1: / Line 1: @@
 ==Background==
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 * Serious pulmonary infection: 6 to 12 months or longer
 * Any non-cutaneous disease in immunocompromised host: at least 12 months, and possibly lifelong suppression

Aidan: Text replacement - " species}}" to ""

2022-01-25T16:40:44Z

Text replacement - " species}}" to ""

← Older revision		Revision as of 16:40, 25 January 2022
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	{{DISPLAYTITLE:''Nocardia'' ~~species}}~~		{{DISPLAYTITLE:''Nocardia''
	[[Category:Gram-positive bacilli]]		[[Category:Gram-positive bacilli]]

Aidan: /* Microbiology */

2021-10-14T16:06:44Z

Microbiology

← Older revision		Revision as of 16:06, 14 October 2021
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	*Beaded [[Stain::Gram-positive]] [[Stain::partially acid-fast]] [[Shape::bacillus]]		*Beaded [[Stain::Gram-positive]] [[Stain::partially acid-fast]] [[Shape::bacillus]]
			*Appearance similar to [[Actinomyces]], differentiated by acid fast staining ([[Actinomyces]] is ''not'' acid fast)

	==Management==		==Management==

Aidan at 17:55, 9 September 2021

2021-09-09T17:55:44Z

← Older revision		Revision as of 17:55, 9 September 2021
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	*Severe: [[Is treated by::TMP-SMX]] plus either [[Is treated by::amikacin]] or [[Is treated by::imipenem]]		*Severe: [[Is treated by::TMP-SMX]] plus either [[Is treated by::amikacin]] or [[Is treated by::imipenem]]
	*Other antimicrobials include [[Is treated by::ceftriaxone]], [[Is treated by::minocycline]], and [[Is treated by:: linezolid]]		*Other antimicrobials include [[Is treated by::ceftriaxone]], [[Is treated by::minocycline]], and [[Is treated by:: linezolid]]

			=== Duration ===

			* Isolated cutaneous infection in immunocompetent host: 3 to 6 months
			* Isolated cutaneous infection in immunocompromised host: 6 to 12 months
			* Serious pulmonary infection: 6 to 12 months or longer
			* Any non-cutaneous disease in immunocompromised host: at least 12 months, and possibly lifelong suppression

Aidan at 17:53, 9 September 2021

2021-09-09T17:53:04Z

← Older revision		Revision as of 17:53, 9 September 2021
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	*Mild to moderate: [[Is treated by::TMP-SMX]]		*Mild to moderate: [[Is treated by::TMP-SMX]]
			**Immunocompetent: 5-10 mg/kg split tid to qid
			**Immunocompromised: 15 mg/kg split tid to qid
	*Severe: [[Is treated by::TMP-SMX]] plus either [[Is treated by::amikacin]] or [[Is treated by::imipenem]]		*Severe: [[Is treated by::TMP-SMX]] plus either [[Is treated by::amikacin]] or [[Is treated by::imipenem]]
	*Other antimicrobials include [[Is treated by::ceftriaxone]], [[Is treated by::minocycline]], and [[Is treated by:: linezolid]]		*Other antimicrobials include [[Is treated by::ceftriaxone]], [[Is treated by::minocycline]], and [[Is treated by:: linezolid]]