Nocardiosis : Report of Three Cases and Review of the Articles

Abstract

Three cases with different clinical manifestations of nocardiosis were reported. Suppurative lymphadenitis at right groin and pulmonary nocardiosis were presented in the first and second cases who also had symptomatic human immunodeficiency virus (HIV) infection. Left subdiaphragmatic abscess was diagnosed in the third case with active systemic lupus erythematosus (SLE) during corticosteroid therapy. The diagnosis of nocardiosis was simply made by Gram and acid-fast or modified acid-fast stains in all cases. Cotrimoxazole, in the dosage of 15 mg/kg/day of trimethoprim, and 75 mg/kg/day of sulfamethoxazole in three divided doses, were given intravenously or orally every eight hours. The therapeutic response was excellent and satisfactorily in two but grave in one case. However, deaths finally ensued in the first and third cases, primarily due to their overwhelming  infections and underlying diseases. In the era of AIDS epidemic and rising immuno-suppression conditions due to other causes, initial and accurate diagnosis of nocardiosis can be reached using Gram and modified acid-fast staining of appropriate clinical specimens in any hospitals where laboratory facility for microbiological culture and identification is limited.