How do I manage nocardiosis?

BackgroundNocardiosis is a rare infection that often difficult to treat and may be life-threatening. There no consensus on its management.ObjectivesOur aim was provide the current evidence for diagnosis management of individuals with nocardiosis, propose approach this uncommon infection.SourcesWe systematically searched medical literature nocardiosis studies published between 2010 2020 describing ten or more individuals.ContentNocardiosis, primarily opportunistic which occur in immunocompetent persons, most commonly involves lungs frequently disseminates other sites including central nervous system. The reference standard Nocardia species identification molecular biology, preferred method antibiotic susceptibility testing (AST) broth microdilution. Monotherapy seems appropriate patients primary skin non-severe pulmonary disease; we reserve multidrug regimen severe infections. Species AST results are missing at initiation antibiotics. Trimethoprim-sulfamethoxazole agent initial therapy, because very susceptible agent, it has been keystone treatment years. Linezolid, almost always susceptible, an alternative. When combination therapy required, repertoire companion drugs includes third-generation cephalosporins, amikacin imipenem. Therapeutic modifications should take into account clinical response results. Treatment duration 6 months situations, but longer durations disseminated shorter reasonable low-risk situations. Secondary prophylaxis considered selected permanent immunosuppression.ImplicationsWe hereby clinician easy-to-use algorithm nocardiosis. We also illuminate gaps suggest future research directions.