pulmonary nocardial infection via hematogenous dissemination

Q: The most common site from pulmonary nocardial infection via hematogenous dissemination is? (select one)

A) brain

B) heart

C) liver

D) kidney

E) intestine

Answer: A

Although nocardia begins as a localized disease at the port of entry, it can disseminate directly or hematogeneously. The two most common entry sites are lungs and skin, with lungs in almost two-thirds of the cases. The most common site of hematogenous dissemination is the brain.

Symptoms begin as fever and cough and progress to night sweats, fatigue, anorexia, weight loss, hemoptysis, dyspnea, and pleuritic chest pain. Almost 50 percent of lung infections disseminate hematogenously, mostly to the brain, irrespective of immunocompetent status. 

Spread to adjacent structures may cause empyema, mediastinitis, pericarditis, and superior vena cava syndrome.

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#neurology

References:

1. Martínez-Barricarte R. Isolated Nocardiosis, an Unrecognized Primary Immunodeficiency? Front Immunol 2020; 11:590239.

2. Coussement J, Lebeaux D, van Delden C, et al. Nocardia Infection in Solid Organ Transplant Recipients: A Multicenter European Case-control Study. Clin Infect Dis 2016; 63:338.

3. Corsini Campioli C, Castillo Almeida NE, O'Horo JC, Challener D, Go JR, DeSimone DC, Sohail MR. Clinical Presentation, Management, and Outcomes of Patients With Brain Abscess due to Nocardia Species. Open Forum Infect Dis. 2021 Apr 7;8(4):ofab067. doi: 10.1093/ofid/ofab067. PMID: 33855101; PMCID: PMC8026153.