Nocardiosis in immunocompromised patients: a single-center experience and systematic review of the literature

Abstract

Nocardiosis is a relatively uncommon but clinically significant infection that mostly affects immunocompromised individuals, frequently requiring prolonged treatment courses and carrying a high mortality rate. To update the current understanding of this disease in immunocompromised patients, we reviewed 10 cases diagnosed in our center and performed a systematic review of the literature from 2012 to 2021. Combining both reviews, disseminated infection was the most common presentation (45% of patients), and the lung was the most commonly involved site (74%). Pharmacological immunosuppression, particularly corticosteroid use (68%), was the most common risk factor and autoimmune and chronic lung diseases were frequently reported as comorbidities. Nocardia farcinica was the most frequently identified species (15%). Trimethoprim-sulfamethoxazole (TMP-SMX) remains the cornerstone of treatment, with a susceptibility rate of 82%. Nocardia-related death occurred in 18% of patients, which emphasizes that nocardiosis remains a challenging disease despite the most recent advances in medical care.