Background: Nocardiosis is a localized or disseminated infection caused by an aerobic actinomycete that usually affects immunocompromised patients. Nocardiosis has been described in patients receiving immunosuppressive therapy, organ transplant recipients, subjects with chronic pulmonary diseases, and patients infected with the human immunodeficiency virus (HIV).Data review: Nocardial infection shows a broad and variable geographic distribution. The clinical forms include pulmonary involvement, skin or soft tissue infection, and disseminated forms with brain and pulmonary lesions. Primary nocardial infection includes pulmonary or cutaneous and/or subcutaneous lesions. Disseminated disease is defined by the identification of nocardial infection in two or more organs. The lung is the most commonly involved organ, followed by the skin and the brain. HIV-related nocardiosis usually appears in patients with advanced immunodepression and CD4 counts less than 50 cells/mL. Sulfonamides are the standard therapy for nocardiosis and are effective in the majority of cases. Several other drugs, such as imipenem, amikacin, minocycline, amoxicillin clavulanic acid and third-generation cephalosporins, have also been used in these patients. Surgery is usually reserved for the drainage of abscesses.Conclusions: Nocardiosis is an important cause of opportunistic infection in immunosuppressed patients. Early recognition and prompt treatment usually results in complete cure, except for patients with nocardial brain abscesses, in whom the mortality remains at approximately 50%.
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