Health Care Workers

Clinical Feature

Overall, 80% of nocardiosis cases present as invasive pulmonary infection, disseminated infection, or brain abscess; 20% present as cellulitis.

Pulmonary infection commonly presents with fever, cough, or chest pain. It can also present as pneumonia, lung abscesses, or cavitary lesions.

Central nervous system (CNS) symptoms include:

• Headache
• Lethargy
• Confusion
• Seizures
• Sudden onset of neurologic deficit

Contiguous spread within the thoracic cavity and hematogenous dissemination, particularly to the CNS, are possible.

Although incidence data are extremely limited, the number of cases is likely rising as a result of the increase in the number of severely immunocompromised people.

Approximately 10% of cases with uncomplicated pneumonia are fatal.

The case-fatality rate increases with overwhelming infection, disseminated disease, or brain abscess. Surgical drainage may be indicated and may improve patient outcome.