Nocardiosis

Nocardiosis is a bacterial infection you can get in your lungs, skin and brain. You get it from breathing in Nocardia bacteria or getting it in your skin. Nocardiosis is rare, but it can be fatal.

Nocardia bacteria are common in the dirt (soil) around us. Most people can breathe in Nocardia without getting sick. But if you have a condition or take medication that weakens your immune system, you’re at a higher risk of nocardiosis. A weakened immune system means you can’t fight off germs as easily as others do.

How common is nocardiosis?

Nocardiosis is rare. Experts estimate that there are between 500 and 1,000 cases in the U.S. each year. About 1% to 4% of people who receive heart or lung transplants get nocardiosis.

What are the symptoms of nocardiosis?

Symptoms of nocardiosis depend on where in your body you’re infected. Symptoms of the most common types of infection (lung and skin) include:

• Skin ulcers or sores
• Bumps under your skin (nodules)
• Cough
• Chest pain
• Shortness of breath
• Fever
• Unexplained weight loss
• Night sweats
• Fatigue, especially fatigue that gets worse over time

If nocardiosis spreads to your brain, symptoms include:

• Headache
• Nausea and vomiting
• Weakness
• Confusion
• Seizures

What does a Nocardia skin infection look like?

If Nocardia bacteria infect your skin, you might get ulcers or sores. These could look like open wounds that are red or discolored, blistered, oozing or crusted. They could also look like bumps under your skin that are red, purple or darker than the surrounding skin. They can be painful.

What causes nocardiosis?

Nocardia bacteria cause nocardiosis. They live in soil in many parts of the world. You can breathe the bacteria into your lungs or get them in your skin. The infection can spread to other parts of your body from there.

How do you get nocardiosis?

You get nocardiosis from:

• Breathing the bacteria in from dirt or dust
• Contaminated medical equipment during surgery (this is rare)
• Getting the Nocardia bacteria in a cut or break in your skin

Injuring yourself while working with dirt (like pricking your finger on a thorn) can force bacteria in. You can also get dirt or contaminated water in an existing cut or wound.

Is nocardiosis contagious?

No, nocardiosis isn’t contagious — it doesn’t spread from person to person.

What are the risk factors for nocardiosis?

You’re more likely to get nocardiosis if you have a weakened immune system, which means you can’t fight off germs as easily as other people. You’re at a higher risk for nocardiosis if you have:

• Had a solid organ transplant, especially a lung or heart transplant
• Had a stem cell transplant, especially if you received stem cells from someone else (allogenic stem cell transplant)
• Cancer
• Diabetes
• HIV
• An autoimmune disease or another condition that requires you to take medications that weaken your immune system (immunosuppressants)
• Chronic lung disease, like COPD

What are the complications of nocardiosis?

Complications include:

• Spreading to other parts of your body from your lungs — like your brain, blood, skin, eyes, kidneys, bone or muscles
• Pneumonia
• Pockets of pus in your lungs (lung abscess)
• Sepsis, a life-threatening reaction to infection
• Respiratory failure
• Organ failure

How is nocardiosis diagnosed?

Healthcare providers usually diagnose nocardiosis by trying to grow (culturing) Nocardia bacteria or PCR testing samples from your body. They might test:

• Biopsies of ulcers on your skin
• Sputum (mucus coughed up from your lungs)
• Samples from bronchial alveolar lavage (fluid collected from your lungs during a bronchoscopy)
• Biopsy from brain abscesses

They might also use chest X-rays or a CT scan to look for an infection in your lungs.

Can nocardiosis be cured?

Nocardiosis can be cured if treated right away. Healthcare providers treat nocardiosis with antibiotics. Your provider may prescribe combinations of antibiotics to get rid of the infection.

You might also need supplemental oxygen or a ventilator if you’re having trouble breathing.

Can nocardiosis be prevented?

You can reduce your risk of nocardiosis by:

• Wearing gloves and a mask if you have to work with dirt or dust
• Wearing clothing that covers your skin to prevent cuts or wounds
• Bandaging any cuts or open wounds in your skin
• Washing your hands frequently, especially after being outdoors or working with dirt and dust.
• Treating injuries right away by washing them with soap and water and covering them. If the wound is very deep, won’t stop bleeding or has dirt or debris that doesn’t wash out, seek immediate medical attention.

If you’re an organ transplant recipient, your provider might prescribe antibiotics to help prevent infections.

What can I expect if I have nocardiosis?

If you have nocardiosis, you’ll need to take antibiotics for six to 12 months. Some people have to take medications for longer than a year to make sure the infection doesn’t come back. It’s important to take any medications as prescribed by your provider, even if you feel better. You may need to stay in the hospital if you’re very sick.

What is the mortality rate of nocardiosis?

Studies suggest that the mortality (death) rate for nocardiosis is between 15% and 40%, and some sources estimate that it’s even higher in certain circumstances. But this depends on many factors, like how severe or widespread the infection is and whether you have a weakened immune system.

When should I see my healthcare provider?

Talk to a healthcare provider if you have symptoms of nocardiosis. If you have a health condition or take medications that can weaken your immune system, it’s important to talk to your provider about how to protect yourself from getting sick and when to seek medical care.

What questions should I ask my provider?

It might be helpful to ask your provider:

• What everyday things can I do to take care of myself?
• What symptoms should I look out for?
• When should I go to the ER?
• When should I follow up with you?
• How do I take my medication?

When should I go to the ER?

Go to the ER if you have signs of serious illness, including:

• Chest pain
• Difficulty breathing
• Confusion or altered mental state
• Seizures
• A wound that won’t heal or is getting bigger
• Large bubbles or blisters in your skin that are red, brown, dark green or black
• Foul-smelling fluid draining from blisters