Cough in Immunosuppressed Patients

Nocardia species

A 33 year old alcoholic was found unconscious behind a restaurant. While recovering in the hospital, he develops cough, fever, and chest pain. Rales are also heard bilaterally. The man has no identification on him and is suspected to be homeless. He admits to being HIV positive.

Labs: Culture reveals branching rods that are weakly-acid fast. Aerobic growth on bacteriology media is also seen.

Discussion: The diagnosis of Nocardiosis is made by labs. The Nocardia species is the cause of Nocardiosis with specifically Nocardia asteroides being the most common causative agent. Most cases occur as opportunistic infection of immunocompromised hosts or hosts with predisposing pulmonary problems. Exposure involves aspiration of soil that contain the Nocardia species.

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