https://doi.org/10.4081/monaldi.2023.2499

Impact of immune status on the clinical characteristics, treatment outcomes and mortality of pulmonary nocardiosis: a retrospective analysis in a tertiary care hospital from a low- to middle-income country

Vol. 94 No. 2 (2024)
Submitted: November 30, 2022
Accepted: June 7, 2023
Published: June 26, 2023
Immune status, pulmonary nocardiosis, Pakistan
Abstract Views: 870
PDF: 170
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Authors

Syed Muhammad Zubair
https://orcid.org/0000-0002-5917-246X
Section of Pulmonary Medicine, Aga Khan University Hospital, Karachi, Pakistan.
Muhammad Mustansir Mehdi Khan
https://orcid.org/0000-0003-2472-0486
Medical College, Aga Khan University, Karachi, Pakistan.
Yasmin Rahim
https://orcid.org/0000-0001-8746-3240
Kettering General Hospital, NHS Foundation Trust, United Kingdom.
Hamza Ahmed Ibad
https://orcid.org/0000-0003-1557-9484
Medical College, Aga Khan University, Karachi, Pakistan.
Muhammad Irfan
muhammad.irfan@aku.edu
https://orcid.org/0000-0002-5796-2548
Section of Pulmonary Medicine, Aga Khan University Hospital, Karachi, Pakistan.

Nocardiosis is an opportunistic infection that primarily targets the immunosuppressed. We investigated the differences in demographics and characteristics between immunosuppressed and immunocompetent patients with nocardiosis in a tertiary care hospital in Pakistan. Retrospective records were reviewed for patients diagnosed with pulmonary nocardiosis between 2010 and 2020. Immunosuppressed individuals were identified as those with autoimmune diseases, hematologic diseases and malignancies, HIV, immunosuppressant therapy, etc. Data collected included basic demographics, comorbid conditions, medication history, clinical presentation, radiological and microbiological data, and nocardiosis outcomes and complications. A total of 66 patients with nocardiosis were included in this study, of whom 48 were immunosuppressed and 18 were immunocompetent. Both groups were compared for a number of variables, including patient characteristics, underlying conditions, radiological findings, treatment regimen, and outcomes. Immunosuppressed individuals were younger and had higher rates of diabetes, chronic renal disease, chronic liver disease, higher platelet counts, surgical intervention, and longer hospital stays. Fever, dyspnea, and sputum production were the most common presentations. Nocardia asteroides was found to be the most common species of Nocardia overall. Nocardiosis presents differently in immunosuppressed and immunocompetent patients, which is consistent with previous studies. Nocardiosis should be considered in any patient presenting with treatment-resistant pulmonary or neurological symptoms.

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Scopus
Google Scholar
Europe PMC
Malani PN. Mandell, Douglas, and Bennett’s Principles and practice of infectious diseases. JAMA 2010;304:206771.
Wilson JW. Nocardiosis: updates and clinical overview. Mayo Clin Proc 2012;87:403-7.
Rathish B, Zito PM. Nocardia. Treasure Island, FL, USA: StatPearls Publishing; 2022.
Beaman BL, Beaman L. Nocardia species: host-parasite relationships. Clin Microbiol Rev 1994;7:213-64.
Kim YK, Sung H, Jung J, et al. Impact of immune status on the clinical characteristics and treatment outcomes of nocardiosis. Diagn Microbiol Infect Dis 2016;85:482-7.
Steinbrink J, Leavens J, Kauffman CA, Miceli MH. Manifestations and outcomes of nocardia infections. Medicine (Baltimore) 2018;97:e12436.
McTaggart LR, Doucet J, Witkowska M, Richardson SE. Antimicrobial susceptibility among clinical Nocardia species identified by multilocus sequence analysis. Antimicrob Agents Chemother 59:269-75.
Schlaberg R, Fisher MA, Hanson KE. Susceptibility profiles of Nocardia isolates based on current taxonomy. Antimicrob Agents Chemother 2014;58:795-800.
MedlinePlus. Immunodeficiency disorders. Available from: https://medlineplus.gov/ency/article/000818.htm. Accessed on: 22/03/2023.
Fernandez J. Overview of immunodeficiency disorders. Available from: https://www.msdmanuals.com/professional/immunology-allergic-disorders/immunodeficiency-disorders/overview-of-immunodeficiency-disorders. Accessed on: 22/03/2023.
National Cancer Institute. Immunosuppression. 2011. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/immunosuppression. Accessed on: 22/03/2023.
De Pauw B, Walsh TJ, Donnelly JP, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008;46:1813-21.
Anagnostou T, Arvanitis M, Kourkoumpetis TK, et al. Nocardiosis of the central nervous system: experience from a general hospital and review of 84 cases from the literature. Medicine (Baltimore) 2014;93:19-32.
Minero MV, Marín M, Cercenado E, et al. Nocardiosis at the turn of the century. Medicine (Baltimore) 2009;88:250-61.
Mootsikapun P, Intarapoka B, Liawnoraset W. Nocardiosis in Srinagarind Hospital, Thailand: review of 70 cases from 19962001. Int J Infect Dis 2005;9:154-8.
Yang M, Xu M, Wei W, et al. Clinical findings of 40 patients with nocardiosis: a retrospective analysis in a tertiary hospital. Exp Therc Med 2014;8:25-30.
Margalit I, Goldberg E, Ben Ari Y, et al. Clinical correlates of nocardiosis. Sci Rep 2020;10:14272.
Martínez Tomás R, Menéndez Villanueva R, Reyes Calzada S, et al. Pulmonary nocardiosis: risk factors and outcomes. Respirology 2007;12:394-400.
Chen J, Zhou H, Xu P, et al. Clinical and radiographic characteristics of pulmonary nocardiosis: clues to earlier diagnosis. PLoS One 2014;9:e90724.
Mehrian P, Esfandiari E, Karimi MA, Memari B. Computed tomography features of pulmonary nocardiosis in immunocompromised and immunocompetent patients. Pol J Radiol 2015;80:13-7.
Blackmon KN, Ravenel JG, Gomez JM, et al. Pulmonary nocardiosis: computed tomography features at diagnosis. J Thorac Imaging 2011;26:224-9.
Haussaire D, Fournier PE, Djiguiba K, et al. Nocardiosis in the south of France over a 10-years period, 2004-2014. Int J Infect Dis 2017;57:13-20.
Zia K, Nafees T, Faizan M, et al. Ten year review of pulmonary nocardiosis: a series of 55 cases. Cureus 2019;11:e4759.

Ethics Approval

The study protocol was approved by the Ethical Review Committee (ERC) of Aga Khan University (ERC No: 2019-0801-1195).

How to Cite

Zubair, Syed Muhammad, Muhammad Mustansir Mehdi Khan, Yasmin Rahim, Hamza Ahmed Ibad, and Muhammad Irfan. 2023. “Impact of Immune Status on the Clinical Characteristics, Treatment Outcomes and Mortality of Pulmonary Nocardiosis: A Retrospective Analysis in a Tertiary Care Hospital from a Low- to Middle-Income Country”. Monaldi Archives for Chest Disease 94 (2). https://doi.org/10.4081/monaldi.2023.2499.
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