A case series of 59 patients with nocardiosis

Nocardial infections have been reported in small case series of patients with multiple risk factors for immunosuppression. We reviewed the microbiology laboratory database for an 11-year period at The Johns Hopkins Hospital and identified 59 patients with nocardiosis. We present their clinical features and outcome. Twentyone of the 59 patients were human immunodeficiency virus infected; all but one had CD4 lymphocyte counts <200 cells/mm³. Each of the nine patients who were solid organ transplant recipients had received his or her transplant within 1 1/2 years of infection. Patients clinically presented with fever (22, 37%), pulmonary symptoms (33, 56%), central nervous system symptoms (17, 29%), and skin/soft tissue manifestations (9, 15%). Five of the 59 patients were receiving trimethoprim-sulfamethoxazole for prophylaxis when they developed nocardia infection. Human immunodeficiency virus-positive patients had a higher death rate (OR = 4.03, p = .02). Six patients were diagnosed with Nocardia postmortem. These data emphasize that Nocardia should be considered in the infectious differential of any immunocompromised patient, regardless of their prophylaxis history.