Impact of immune status on the clinical characteristics, treatment outcomes and mortality of pulmonary nocardiosis: a retrospective analysis in a tertiary care hospital from a low to middle-income country

Submitted: November 30, 2022
Accepted: June 7, 2023
Published: June 26, 2023
Abstract Views: 515
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Nocardiosis is an opportunistic infection that primarily targets the immunosuppressed. We investigate the differences in demographics and characteristics between immunosuppressed and immunocompetent patients with nocardiosis in a tertiary care hospital in Pakistan. Retrospective records were reviewed for patients diagnosed with pulmonary nocardiosis between 2010 and 2020. Immunosuppressed individuals were identified as those with autoimmune diseases, hematologic diseases and malignancies, HIV, immunosuppressant therapy, etc. Data collected included basic demographics, comorbid conditions, medication history, clinical presentation, radiological and microbiological data, and nocardiosis outcomes and complications. A total of 66 patients with nocardiosis were included in this study out of which 48 were immunosuppressed while 18 were immunocompetent. Both groups were compared for a number of variables including patient characteristics, underlying conditions, radiological findings, treatment regimen and outcomes. Immunosuppressed individuals were younger, and had higher rates of diabetes, chronic renal disease, chronic liver disease, higher platelet counts, surgical intervention, and longer hospital stays. Fever, dyspnea, and sputum production were the most common presentations. Nocardia asteroides was found to be the most common species of Nocardia overall. Nocardiosis presents differently in patients with immunosuppressed and immunocompetent patients consistent with previous studies. Nocardiosis should be considered in any patient presenting with treatment-resistant pulmonary or neurological symptoms.



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Malani PN. Mandell, Douglas, and Bennett’s Principles and practice of infectious diseases. JAMA 2010;304:206771. DOI:
Wilson JW. Nocardiosis: updates and clinical overview. Mayo Clin Proc 2012;87:4037. DOI:
Rathish B, Zito PM. Nocardia. StatPearls [Internet]. Treasure Island: StatPearls Publishing; 2022. Accessed: 2022 Apr 16. Available from:
Beaman BL, Beaman L. Nocardia species: host-parasite relationships. Clin Microbiol Rev 1994;7:21364. DOI:
Kim YK, Sung H, Jung J, et al. Impact of immune status on the clinical characteristics and treatment outcomes of nocardiosis. Diagn Microbiol Infect Dis 2016;85:4827. DOI:
Steinbrink J, Leavens J, Kauffman CA, Miceli MH. Manifestations and outcomes of Nocardia infections. Medicine (Baltimore) 2018 5;97:e12436. DOI:
McTaggart LR, Doucet J, Witkowska M, Richardson SE. Antimicrobial susceptibility among clinical Nocardia species identified by multilocus sequence analysis. Antimicrob Agents Chemother 59:26975. DOI:
Schlaberg R, Fisher MA, Hanson KE. Susceptibility profiles of Nocardia isolates based on current taxonomy. Antimicrob Agents Chemother 2014;58:795800. DOI:
MedlinePlus Medical Encyclopedia [Internet]. Immunodeficiency disorders. Accessed: 2023 Mar 22. Available from:
MSD Manual [Internet]. Overview of immunodeficiency disorders. Accessed: 2023 Mar 22. Available from:
National Cancer Institute [Internet]. Immunosuppression. 2011. Accessed: 2023 Mar 22. Available from:
De Pauw B, Walsh TJ, Donnelly JP, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008;46:181321. DOI:
Anagnostou T, Arvanitis M, Kourkoumpetis TK, et al. Nocardiosis of the central nervous system: experience from a general hospital and review of 84 cases from the literature. Medicine (Baltimore) 2014;93:1932. DOI:
Minero MV, Marín M, Cercenado E, et al. Nocardiosis at the turn of the century. Medicine (Baltimore) 2009;88:25061. DOI:
Mootsikapun P, Intarapoka B, Liawnoraset W. Nocardiosis in Srinagarind Hospital, Thailand: review of 70 cases from 19962001. Int J Infect Dis 2005;9:1548. DOI:
Yang M, Xu M, Wei W, et al. Clinical findings of 40 patients with nocardiosis: A retrospective analysis in a tertiary hospital. Exp Therc Med 2014;8:2530. DOI:
Margalit I, Goldberg E, Ben Ari Y, et al. Clinical correlates of nocardiosis. Sci Rep 2020;10:14272. DOI:
Martínez Tomás R, Menéndez Villanueva R, Reyes Calzada S, et al. Pulmonary nocardiosis: risk factors and outcomes. Respirology 2007;12:394400. DOI:
Haussaire D, Fournier PE, Djiguiba K, et al. Nocardiosis in the south of France over a 10-years period, 20042014. Int J Infect Dis 2017;57:1320. DOI:
Chen J, Zhou H, Xu P, et al. Clinical and radiographic characteristics of pulmonary nocardiosis: clues to earlier diagnosis. PLoS One 2014;9:e90724. DOI:
Mehrian P, Esfandiari E, Karimi MA, Memari B. Computed tomography features of pulmonary nocardiosis in immunocompromised and immunocompetent patients. Pol J Radiol 2015;80:137. DOI:
Blackmon KN, Ravenel JG, Gomez JM, et al. Pulmonary nocardiosis: computed tomography features at diagnosis. J Thorac Imaging 2011;26:2249. DOI:
Zia K, Nafees T, Faizan M, et al. Ten year review of pulmonary nocardiosis: a series of 55 cases. Cureus 2019;11:e4759. DOI:

Ethics Approval

The study protocol was approved by the Ethical Review Committee (ERC) of Aga Khan University

How to Cite

Zubair, Syed Muhammad, Muhammad Mustansir Mehdi Khan, Yasmin Rahim, Hamza Ahmed Ibad, and Muhammad Irfan. 2023. “Impact of Immune Status on the Clinical Characteristics, Treatment Outcomes and Mortality of Pulmonary Nocardiosis: A Retrospective Analysis in a Tertiary Care Hospital from a Low to Middle-Income Country”. Monaldi Archives for Chest Disease, June.