CHANGING SPECTRUM OF NOCARDIOSIS - A REVIEW AND PRESENTATION OF 9 CASES

Abstract

Nocardiosis was once considered a clinical and laboratory curiosity. More complete bacteriologic studies on appropriate media, kept long enough to detect slow-growing colonies, have added to the number of cases recognized in the past decade. Although better means of detection have undoubtedly increased the apparent frequency of the disease, the incidence appears also to be rising due to a greater susceptibility of the human host. Nocardiosis is one of the infections that may occur when there has been an alteration in the host''s defenses and normal bacterial flora; this predilection for infection may be part of a disease process or it may be induced by therapeutic measures (especially acirenocortical steroids). Nine cases of nocardiosis are presented in addition to a review of fundamental aspects of bacteriology, pathology, and treatment. One of the most notable characteristics was the variety of disease encountered. The most common form was acute bronchopneumonia, often with empyema and/or chest wall extension. Three patients had generalized nocardiosis with brain abscesses. Two of the patients developed nocardiosis as a complication of high-dosage adrenocortical steroid therapy, and a third patient with dysproteinemia who had received long-term antimicrobials died from nocardial bronchopneumonia. Requisite for improving survival in nocardiosis are awareness of the potentialities of the infection and adequate medical and surgical therapy. This is especially true when underlying circumstances enhance secondary infection.