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History Nocardiosis is difficult to diagnose clinically, radiologically, and histopathologically. Making the diagnosis may often involve performing invasive techniques on the patient and may take up to 2 or 3 weeks.
However, despite recent taxonomic changes, there is evidence that this genus is still underspeciated. For culture they require aerobic conditions, but growth on blood agar may be slow, and incubation for periods longer than 48 h is usually necessary.
As cultures enter the stationary phase, the filaments tend to fragment into coccobacillary forms. Although the organisms are gram positive, many strains give a faint beaded appearance with alternating positive and negative areas.
Interpretation of these data may be complicated by several factors. When data are from a reference laboratory that is likely to receive referral isolates from patients who are intolerant of therapy or for whom therapy has failed, there is a potential for bias in their interpretation.
Based on recommendations from Tindall et al. Speciation of isolates suspected of being an aerobic actinomycete requires a 16S rRNA gene sequence with a minimum length of bp. Limitations to identifying aerobic actinomycetes by molecular methods include: It is recommended to send clinical isolates to a reference laboratory for confirmation of identification when adequate sequencing technology and analysis are unavailable.
These infections may be localized or disseminated and are more common and generally more serious in severely immunocompromised and debilitated patients.
Cases may go undiagnosed, either because there is a delay in performing necessary diagnostic tests invasive biopsies for seriously ill patients or because the infection partially or successfully responds when prophylactic broad-spectrum antimicrobial therapy is prescribed Pu lmonary Nocardiosis Pulmonary nocardiosis may be associated with nonspecific clinical findings; however, immunocompetent patients may have a chronic course, as opposed to the progressive, disseminated, and life-threatening infection seen in severely immunocompromised patients.
Metastatic infective foci may be present but unrecognized at the time of the patient's initial presentation with pulmonary nocardiosis, and infection in these sites may not become clinically evident until after the patient has begun receiving antimicrobial therapy. D isseminated Nocardiosis Disseminated nocardiosis is often a late-presenting and potentially life-threatening infection.
It is most frequently endogenous i.
However, very rarely, it may result from a primary nonpulmonary cutaneous infection site In patients with primary pulmonary nocardiosis, the development of disseminated infection may result in brain and skin lesions and invariably has a significant adverse effect on the patient's prognosis.
As seen with pulmonary nocardiosis, the patients at highest risk for developing disseminated infections are severely immunocompromised patients. The brain is the most frequent nonpulmonary site involved in disseminated nocardiosis, and cerebral nocardiosis is an important cause of cerebral space occupying lesions.
However, the infection may also involve multiple other deep organs including the kidney, spleen, liver, and rarely, bone, skin, and joints MIS Week 1 Assignment 3 Publisher Shipping Decision Problem.
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