Severe pulmonary nocardiosis — including disseminated nocardiosis and progressive pulmonary infection — presents a distinct management challenge. Affected patients are typically immunocompromised, require hospitalisation, and follow a rapid clinical course from onset to diagnosis.
Immunocompromised patient hospitalised with severe pulmonary nocardiosis; disseminated nocardiosis or progressive pulmonary infection; rapid clinical course.
Empiric combination therapy with 2 or 3 agents is initiated upfront given the severity of disease. Treatment is subsequently narrowed once susceptibility data are available and clinical improvement is evident. The complete regimen, agent selection, sequencing, and duration are detailed in the structured protocol.
Signs of clinical improvement and radiographic response on follow-up chest imaging.
DOI: 10.1093/cid/ciae643
In contrast, patients with severe nocardiosis are typically hospitalized and have a more rapid course from onset to diagnosis.
This is particularly crucial in severe forms of nocardiosis (eg, disseminated or progressive pulmonary infection), where 2 or 3 different agents are typically initiated empirically.
Once Nocardia susceptibility is determined, antibiotic therapy can be further tailored.
If combination therapy is started empirically, treatment can be narrowed to monotherapy, particularly if there are signs of clinical improvement.
Patients with pulmonary or CNS disease should undergo follow-up chest or brain imaging, respectively, to evaluate for response to treatment.
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