Title:Nocardia Infections: Ten Years Experience from a Tertiary Health Care Center in North India (2007-2016)
Volume: 21
Issue: 3
Author(s): Yashik Bansal, Nidhi Singla*, Hena Butta, Deepak Aggarwal, Neelam Gulati and Jagdish Chander
Affiliation:
- Department of Microbiology, Government Medical College Hospital, Sector 32, Chandigarh,India
Keywords:
Nocardia, actinomycetes, pulmonary nocardiosis, mycetoma, sputum, KOH.
Abstract:
Background: Nocardia species are important cause of infections in humans but are underreported
due to missed diagnosis as well as misdiagnosis. Majority of the literature on these infections
consists of case reports or series with few articles describing high number of cases.
Objective: To study the epidemiology of Nocardia infections in a tertiary care center.
Materials and Methods: This retrospective observational study was done in a tertiary care centre
of North India over a period of 10 years (2007-2016). The detection of Nocardia spp. from clinical
specimens was done by conventional methods viz. direct microscopy (Gram’s stain, modified Ziehl
-Neelsen stain [1%], KOH examination) and culture.
Results: A total of 25 cases of nocardiosis were diagnosed during the study period. The mean age
of the patients was 50.9 years (range 30-72 years) with a male:female ratio of 3:2. The site of disease
in these patients included pulmonary (n=18), cutaneous (n=4), perinephric abscess (n=1), ocular
(n=1) and bone (n=1). Risk factors associated were underlying lung disease (n=11), smoking
(n=7), diabetes (n=5) and steroid therapy (n=4) in pulmonary nocardiosis, iatrogenic (n=1) and leprosy
(n=1) in cutaneous nocardiosis, diabetes in perinephric abscess and cataract surgery in ocular
nocardiosis. Culture was positive in 12/25 (48%) patients for Nocardia spp. Direct microscopy
was positive in 22 patients. We wish to highlight that meticulous observation of KOH wet mount
examination helped in clinching the diagnosis of Nocardiosis in 3 cases which were earlier missed
by other methods.
Conclusion: Good communication with the clinician alongside a meticulous effort in the laboratory
is essential for appropriate diagnosis and management of these cases.
