Lung abscess, immunocompromised patient and steroids

Q: Which of the following organism should be suspected and covered in lung abscess in an immunocompromised patient on prolonged glucocorticoids? 

 A) Pneumocystis pneumonia (PCP) 
 B) Staphylococcus aureus 
C) Klebsiella 
D) Nocardia 
 E) Anaerobic infection


Answer:  D

 The common organisms in lung abscess in an immunocompromised patient include Pseudomonas aeruginosa, Aspergillus, Cryptococcus spp, mucormycosis, Mycobacterium tuberculosis, PCP and nontuberculous mycobacteria.

Nocardia goes high on the list if an immunocompromised patient is on a prolonged course of glucocorticoids.


#infectiousdiseases
#pulmonary



References:

1. Beaman BL, Beaman L. Nocardia species: host-parasite relationships. Clin Microbiol Rev 1994; 7:213.

2. Ambrosioni J, Lew D, Garbino J. Nocardiosis: updated clinical review and experience at a tertiary center. Infection 2010; 38:89. 

3. 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.