title: Nocardiosis in the south of France over a 10-years period, 2004-2014.
abstract: BACKGROUND
  Nocardiosis is a rare disease with polymorphic presentations. The epidemiology and clinical presentation could change with the increasing number of immunocompromised patients.
  
  
  METHODS
  The medical records and microbiological data of patients affected by nocardiosis and treated at the university hospitals of Marseille between 2004 and 2014 were analyzed retrospectively.
  
  
  RESULTS
  The cases of 34 patients infected by Nocardia spp during this period were analyzed. The main underlying conditions were transplantation (n=15), malignancy (n=9), cystic fibrosis (n=4), and immune disease (n=3); no immunodeficiency condition was observed for three patients. No case of AIDS was observed. At diagnosis, 61.8% had received steroids for over 3 months. Four clinical presentations were identified, depending on the underlying condition: the disseminated form (50.0%) and the visceral isolated form (26.5%) in severely immunocompromised patients, the bronchial form (14.7%) in patients with chronic lung disease, and the cutaneous isolated form (8.8%) in immunocompetent patients. Nocardia farcinica was the main species identified (26.5%). Trimethoprim-sulfamethoxazole was prescribed in 68.0% of patients, and 38.0% underwent surgery. Mortality was 11.7%, and the patients who died had disseminated or visceral nocardiosis.
  
  
  CONCLUSIONS
  The clinical presentation and outcome of nocardiosis depend on the patient's initial immune status and underlying pulmonary condition. Severe forms were all iatrogenic, occurring after treatments altering the immune system.
authors.affiliation: Department of Nephrology, AP-HM, Aix-Marseille University, Hôpital de la Conception, 147,boulevard Baille, 13385 Marseille cedex 5, France. Electronic address: delphaus@aol.com.
authors.forename: Delphine
authors.initials: D
authors.lastname: Haussaire
authors.affiliation: Department of Infectious Diseases, AP-HM, Aix-Marseille University, Hôpital de la Timone, Marseille, France.
authors.forename: Pierre-Edouard
authors.initials: PE
authors.lastname: Fournier
authors.affiliation: Department of Nephrology, AP-HM, Aix-Marseille University, Hôpital de la Conception, 147,boulevard Baille, 13385 Marseille cedex 5, France.
authors.forename: Karamoko
authors.initials: K
authors.lastname: Djiguiba
authors.affiliation: Department of Nephrology, AP-HM, Aix-Marseille University, Hôpital de la Conception, 147,boulevard Baille, 13385 Marseille cedex 5, France.
authors.forename: Valerie
authors.initials: V
authors.lastname: Moal
authors.affiliation: Department of Nephrology, AP-HM, Aix-Marseille University, Hôpital de la Conception, 147,boulevard Baille, 13385 Marseille cedex 5, France.
authors.forename: Tristan
authors.initials: T
authors.lastname: Legris
authors.affiliation: Department of Nephrology, AP-HM, Aix-Marseille University, Hôpital de la Conception, 147,boulevard Baille, 13385 Marseille cedex 5, France.
authors.forename: Rajsingh
authors.initials: R
authors.lastname: Purgus
authors.affiliation: Department of Pneumology and Lung Transplantation, AP-HM, Aix-Marseille University, Hôpital Nord, Marseille, France.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Bismuth
authors.affiliation: Department of Multidisciplinary Oncology and Therapeutic Innovations, Aix Marseille University, Hôpital Nord, Marseille, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Elharrar
authors.affiliation: Department of Pneumology and Lung Transplantation, AP-HM, Aix-Marseille University, Hôpital Nord, Marseille, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Reynaud-Gaubert
authors.affiliation: Department of Nephrology, AP-HM, Aix-Marseille University, Hôpital de la Conception, 147,boulevard Baille, 13385 Marseille cedex 5, France. Electronic address: Henri.VACHERCOPONAT@ap-hm.fr.
authors.forename: Henri
authors.initials: H
authors.lastname: Vacher-Coponat
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003550:Cystic Fibrosis / Q000150:complications; D005260:Female; D005602:France; D049674:History, 21st Century; D006785:Hospitals, University; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D009615:Nocardia; D009617:Nocardia Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000266:history; D012189:Retrospective Studies; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: Cancer; Cystic fibrosis; Nocardiosis; Opportunistic infection; Transplantation