J Korean Med Sci.  2024 Mar;39(11):e107. 10.3346/jkms.2024.39.e107.

Comparative Analysis of CT Findings and Clinical Outcomes in Adult Patients With Disseminated and Localized Pulmonary Nocardiosis

• Lee HN
• Do KH
• Kim EY
• Choe J
• Sung H
• Choi SH
• Kim HJ

• KMID: 2554205
• DOI: http://doi.org/10.3346/jkms.2024.39.e107

Abstract

Background
Pulmonary nocardiosis is a rare opportunistic infection with occasional systemic dissemination. This study aimed to investigate the computed tomography (CT) findings and prognosis of pulmonary nocardiosis associated with dissemination.
Methods
We conducted a retrospective analysis of patients diagnosed with pulmonary nocardiosis between March 2001 and September 2023. We reviewed the chest CT findings and categorized them based on the dominant CT findings as consolidation, nodules and/ or masses, consolidation with multiple nodules, and nodular bronchiectasis. We compared chest CT findings between localized and disseminated pulmonary nocardiosis and identified significant prognostic factors associated with 12-month mortality using multivariate Cox regression analysis.
Results
Pulmonary nocardiosis was diagnosed in 75 patients, of whom 14 (18.7%) had dissemination, including involvement of the brain in 9 (64.3%) cases, soft tissue in 3 (21.4%) cases and positive blood cultures in 3 (21.4%) cases. Disseminated pulmonary nocardiosis showed a higher frequency of cavitation (64.3% vs. 32.8%, P = 0.029) and pleural effusion (64.3% vs. 29.5%, P = 0.014) compared to localized infection. The 12-month mortality rate was 25.3%. The presence of dissemination was not a significant prognostic factor (hazard ratio [HR], 0.80; confidence interval [CI], 0.23–2.75; P = 0.724). Malignancy (HR, 9.73; CI, 2.32–40.72; P = 0.002), use of steroid medication (HR, 3.72; CI, 1.33–10.38; P = 0.012), and a CT pattern of consolidation with multiple nodules (HR, 4.99; CI, 1.41–17.70; P = 0.013) were associated with higher mortality rates.
Conclusion
Pulmonary nocardiosis with dissemination showed more frequent cavitation and pleural effusion compared to cases without dissemination, but dissemination alone did not affect the mortality rate of pulmonary nocardiosis.

Keyword

Pulmonary Nocardiosis; Computed Tomography; Prognosis; Dissemination

Figure

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  Fig. 1 Four representative patterns of pulmonary nocardiosis. (A) Consolidation: CT scan of a 51-year-old woman with underlying breast cancer. Segmental consolidation with internal necrotic change is evident in the right lower lobe. (B) Nodules and/or masses: CT scan of a 75-year-old woman with a post-transplantation state of the liver. Two large cavitary masses are evident in both upper lobes and several nodules in the right lung. (C) Consolidation with multiple nodules: CT scan of a 68-year-old man taking steroid medication. Segmental consolidation is shown in the right lower lobe and several nodules are noted in the right middle lobe and both lower lobes (arrows). (D) Nodular bronchiectasis: CT scan of a 47-year-old woman with a nodular bronchiectasis pattern. Multiple centrilobular nodules and bronchiectasis are noted in the right middle lobe and both lower lobes.CT = computed tomography.

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  Fig. 2 Flow chart of included patients with pulmonary nocardiosis.CT = computed tomography.

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  Fig. 3 Isolated Nocardia species.

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  Fig. 4 Kaplan-Meier curves for overall survival. (A) Overall survival according to localized and disseminated pulmonary nocardiosis. (B) Overall survival according to computed tomography pattern.

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