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Clinical manifestations and diagnosis of nocardiosis

Denis Spelman, MBBS, FRACP, FRCPA, MPH
Section Editor
Daniel J Sexton, MD
Deputy Editor
Anna R Thorner, MD


Nocardiosis is an uncommon gram-positive bacterial infection caused by aerobic actinomycetes in the genus Nocardia. Nocardia spp have the ability to cause localized or systemic suppurative disease in humans and animals [1-5]. Nocardiosis is typically regarded as an opportunistic infection, but approximately one-third of infected patients are immunocompetent [5]. (See "Microbiology, epidemiology, and pathogenesis of nocardiosis", section on 'Immunocompromise'.)

The major clinical manifestations and diagnosis of nocardiosis will be reviewed here. Two characteristics of nocardiosis are its ability to disseminate to virtually any organ, particularly the central nervous system, and its tendency to relapse or progress despite appropriate therapy.

The classification of nocardiosis is based upon the location and extent of disease and includes pulmonary, central nervous system, cutaneous, and disseminated disease [2,6]. Although there are no pathognomonic signs or symptoms of nocardiosis, it should be suspected in any patient who presents with brain, soft tissue, or cutaneous lesions and a concurrent or recent pulmonary process.

The microbiology, epidemiology, pathogenesis, and treatment of Nocardia infection are discussed separately. (See "Microbiology, epidemiology, and pathogenesis of nocardiosis" and "Treatment of nocardiosis".)


The risk of nocardial infection is increased in immunocompromised patients, particularly those with defects in cell-mediated immunity [4]. In a literature review of over 1000 cases, 64 percent of patients with nocardiosis were immunocompromised [5]. (See "Microbiology, epidemiology, and pathogenesis of nocardiosis", section on 'Immunocompromise'.)

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Literature review current through: Nov 2017. | This topic last updated: Jul 27, 2017.
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