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Roderick J. Hay


August 28, 2014: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.



Laboratory diagnosis—updated.

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date: 27 September 2021

Nocardia species—Nocardia asteroides, N. brasiliensis, and N. otidiscaviarum—are Gram-positive, filamentous, partially acid-fast bacteria. They are occasionally detectable in environmental sources such as soil, but they rarely cause infections in humans, although they can give rise to a variety of different diseases. In healthy individuals, most commonly in the tropics, they can present with cutaneous abscesses or subcutaneous infections (actinomycetoma) in which the organisms are present as clusters of filaments or grains. In immunocompromised patients they cause a disseminated or localized deep infection, with particular sites affected being the lungs or brain. Diagnosis of nocardial infection depends on culture, although histopathology is very useful in nocardial actinomycetomas. Antibiotic treatment is typically with a sulphonamide (often as co-trimoxazole for lung infections), but combinations of drugs are usually given because the responsiveness of Nocardia species is very variable....

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