Free Medical Books Respiratory Medicine

ACCP Pulmonary Medicine Board Review 25th Edition

ACCP Pulmonary Medicine Board Review 25th Edition PDF

ACCP Pulmonary Medicine Board Review 25th Edition PDF
 Author American College of Chest Physicians
Isbn 978-0916609771
File size 6 MB
Year 2009
Pages
Language English
PDF
Category Free Medical Books
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Book Description
Unusual Lung Infections
Nocardiosis
Nocardiosis refers to invasive disease caused
by members of the genus Nocardia. Respiratory
tract disease and extrapulmonary dissemination
are the most common manifestations. Pulmonary
infection is increasingly seen in immunosuppressed
patients, particularly those with defects in
cellular immunity. Other presentations include
cellulitis, lymphocutaneous syndrome, actinomycetoma,
and keratitis. Nocardia species are aerobic,
nonmobile, and non-spore-forming organisms that
live as soil saprophytes. In tissue specimens, the
organisms reveal delicate branching fi lamentous
forms that are Gram-positive and usually acid fast
if weak decolorizing agents are used for the stains.
Seven species have been associated with human
disease. Nocardia asteroides is the most common
species associated with invasive disease. Nocardia
farcinica is less common and is associated with dissemination.
Other species known to cause human
infection are Nocardia pseudobrasiliensis and Nocardia
brasiliensis.
Epidemiology/Pathogenesis: Nocardia species
are common natural inhabitants of the soil
throughout the world. Epidemics within the hospital
environment are rare, and person-to- person
transmission has only rarely been suggested.
Although Nocardia can occur as a primary pulmonary
pathogen in patients with no underlying
disease and can complicate surgery or trauma,
it is frequently recognized as an opportunistic
disease, especially among patients with cellmediated
immune defi ciencies, including transplantation
(greatest frequency in those who have
undergone lung transplantation), lymphoma,
and AIDS. High-dose corticosteroids, cytomegalovirus
infection in the past 6 months, and high
calcineurin inhibitor levels (cyclosporine or tacrolimus)
are independent risk factors for Nocardia
infection in organ transplant recipients. In
HIV-positive persons, nocardiosis most often presents
with a CD4 lymphocyte concentration of
 100 cells/μL but can occur in patients with
counts  250 cells/μL…