title: Nocardiosis: a 15-year experience in a tertiary medical center in Israel.
abstract: OBJECTIVE
  The objective of this study is to characterize the common risk factors, clinical presentation, imaging findings, treatment and outcome of nocardial infection.
  
  
  METHODS
  A retrospective cohort study. We reviewed the charts of all patients with nocardiosis in the Chaim Sheba Medical Center, a tertiary medical center in Israel, between the years 1996 and 2011.
  
  
  RESULTS
  A total of 39 patients who had positive culture of Nocardia were analyzed. The majority of our patients were immunocompromised (74.5%), mostly due to corticosteroid therapy. None had HIV/AIDS. The clinical presentation was either acute or a chronic smoldering illness. The three major clinical syndromes were pleuropulmonary, neurological and skin/soft tissue infection about 20.5% each. Pathology in the lungs was seen in most of the patients by CT scan; discrete nodules and wedge shaped pleural based consolidations were the most frequent findings. Brain lesions consistent with abscesses were detected in 10 patients by brain imaging. Some cases had relapsing disease in spite of antimicrobial treatment. 25% of examined isolates were resistant to trimethoprim/sulfamethoxazole. The duration of intravenous antimicrobial treatment ranged from one month to over a year in the severe cases. One year mortality rate was 32%.
  
  
  CONCLUSIONS
  Nocardiosis requires a high clinical index of suspicion in order to diagnose and treat promptly. Disease extent and bacterial susceptibility have important implications for prognosis and treatment.
authors.affiliation: Internal Medicine D, The Chaim Sheba Medical Center, Tel Hashomer, Israel. rosmanyossi@gmail.com
authors.forename: Yossi
authors.initials: Y
authors.lastname: Rosman
authors.forename: Ehud
authors.initials: E
authors.lastname: Grossman
authors.forename: Nathan
authors.initials: N
authors.lastname: Keller
authors.forename: Michael
authors.initials: M
authors.lastname: Thaler
authors.forename: Tali
authors.initials: T
authors.lastname: Eviatar
authors.forename: Chen
authors.initials: C
authors.lastname: Hoffman
authors.forename: Sarah
authors.initials: S
authors.lastname: Apter
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000583:Amikacin / Q000627:therapeutic use; D015780:Carbapenems / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D015331:Cohort Studies; D004660:Encephalitis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009617:Nocardia Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D011001:Pleuropneumonia / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D017192:Skin Diseases, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D018461:Soft Tissue Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D015780:Carbapenems; D002443:Ceftriaxone; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000583:Amikacin
keywords: Corticosteroid treatment; Immunocompromised; Nocardia