Study of Nocardia in HIV positive chest symptomatic individuals.

Introduction: Pulmonary nocardiosis is a well-described infection in patients with neoplastic disease, human immunodeficiency virus (HIV) infection. The radiographic appearance of pulmonary nocardiosis is varied and nonspecific. Since the clinical and radiologic manifestations are non-specific, and the microbiological diagnosis is often difficult. In some patients, pulmonary nocardiosis will be mistaken for other infections, such as tuberculosis or bacterial pneumonia. Hence this study was undertaken to detect the prevalence of nocardiasis in HIV infected patients. Material and Methods: One hundred chest symptomatic patients screened for HIV infection and the samples of HIV positive patient processed for Nocardia using kinyoun’s modification of zeihl Neelsen stain and culture. The CD4 count of HIV patients with Nocardial infection and co-infection by mycobacterium tuberculosis studied. Observations: Out of 100 patients with cough and fever more than 2 weeks, 58 turned out to be HIV positive. Most of the patients included in the study were in their 3rd and 4th decades of life. The male to female ratio was 1:0.38. The open tuberculosis cases were 43.45% and sputum positive for acid fast bacilli. The nocardiosis was observed in 3.45% cases by modified Kinyoun’s method of staining and culture. In 80.65% tuberculosis cases, CD4 count less than 200/μl, while 19.35% had CD4 count more than 200/μl. The cases with nocardiosis had CD4 count less than 200/μl. Co-infection with tuberculosis and nocardiosis is not observed. The history of family contact for tuberculosis was found in 9.68% cases. Conclusion: The prevalence of nocardia in HIV positive individuals for north Maharashtra region is observed. The nocardia are easy to treat if diagnosed correctly and this will help in preventing morbidity in chest symptomatic patients. Unnecessary treatment with higher antibiotics can be avoided and cost effective treatment will be possible. Patients with CD4+ count less than 200 cells/μl should be screened for Nocardia. [Ravindra K NJIRM 2016; 7(5):73-77]

An infection in disguise.

Nocardia is gram positive partially acid fast bacilli and widely present in soil, fresh water, marine water, organic matter habitats and so saprophytic in existence Nocardiasis is a rare bacterial infection and thus bacteria can be localized or systemic suppurative disease in humans. They may be rarely present on the skin and in the upper respiratory tract. Here we present a rare case of buccal space infection where in the culture reported nocardial infection. In our case the nocardiosis seems to be opportunistic and could have been inoculated following fall in the mud in this alcoholic state. Patient was treated with Amoxicillin-clavulanic acid and Amikacin and he responded well.