Nocardial mycetoma: diverse clinical presentations.
Nocardia spp are gram-positive, aerobic, acid-fast bacteria which exist as saprophytes in nature. Invasive disseminated infections are particularly common in immunocompromised or debilitated hosts. Superficial infections with Nocardia spp occur as a result of local trauma and contamination of the wound. Clinically, it presents as acute infection (abscesses or cellulitis), mycetoma, or sporotrichoid infection. Differential diagnosis includes eumycetoma, chromomycosis, blastomycosis, coccidioidomycosis, sporotrichosis, tuberculosis, botryomycosis, syphilis, yaws, and neoplasia. Its diagnosis is confirmed by demonstrating the causative organism in exudates (as granules), tissue specimens, or cultures. Early diagnosis will obviate need for drastic surgical measures as early institution of chemotherapy is effective in most patients. However, its diagnosis is often delayed due to diverse clinical presentations and for want of clinical suspicion, particularly in non-endemic areas. This paper presents 4 clinical forms of this not so uncommon disease, emphasizing the importance of high index of clinical suspicion, especially in non-endemic regions; and the significance of repeated examination of exudates for Nocardia granules for an early diagnosis.
Sharma
Nand Lal
NL
Department of Dermatology, Venereology and Leprosy, Indira Gandhi Medical College, Shimla, India. nandlals@hotmail.com
Mahajan
Vikram K
VK
Agarwal
Santwana
S
Katoch
Vishwa Mohan
VM
Das
Ram
R
Kashyap
Meera
M
Gupta
Poonam
P
Verma
Ghanshyam K
GK
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008271:Mycetoma / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D009615:Nocardia; D009617:Nocardia Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology
D000900:Anti-Bacterial Agents