Background
Microbiology
- Beaded Gram-positive partially acid-fast bacillus
- Appearance similar to Actinomyces, differentiated by acid fast staining (Actinomyces is not acid fast)
Management
- Mild to moderate: TMP-SMX
- Immunocompetent: 5-10 mg/kg split tid to qid
- Immunocompromised: 15 mg/kg split tid to qid
- Severe: TMP-SMX plus either amikacin or imipenem
- Other antimicrobials include ceftriaxone, minocycline, and 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
