Disseminated #nocardia
#Nocardia aerobic, partially acid-fast, branching, filamentous, slow growing Gram-positive bacilli. Infection acquired by direct inoculation or inhalation & spreads hematogenously from lungs. Six forms: pulmonary, systemic, CNS, extrapulmonary, cutaneous & actinomycetoma
Nocardiosis is mostly seen in severely immunosuppressed patients such as with HIV, organ transplantation, corticosteroid therapy, autoimmune conditions, COPD, and malignancy. TMP/SXT prophylaxis is used in at risk pts
DDX TB generally has initial pulmonary presentation & prolonged spread to skin, joint & CNS would be unusual. Actinomycosis rarely presents in CNS & skin lesions arise by contiguous spread. Endemic fungi skin nodules but would not remain nodular over a period of years
https://cmr.asm.org/content/21/2/305
https://www.cdc.gov/nocardiosis/health-care-workers/index.html
http://www.antimicrobe.org/b117.asp
Brain+Lung infections DDX:
mixed strep/anerobes
strep
staph
septic emboli,
klebseilla
nocardia
MTB
rhodococcus
cryptococcus
mucor
fusarium
aspergillus
dematiaceous fungi
blastomycosis
burkholderia,
scedosporium
Originally tweeted by Indiana University Infectious Diseases Fellowship (@IUIDfellowship) on 16 November, 2020.