microbiological challenge . Nocardia infection in AIDS : a clinical and

A case of Nocardia asteroides pneumonia was diagnosed after death in a patient with AIDS. Six sputum cultures and one bronchoalveolar lavage fluid contained no pathogens, and no growth was obtained from one pleural fluid aspirate. None of these specimens was incubated for more than two days. Extended incubation for mycobacteria also failed to help in the diagnosis. N asteroides was isolated from pus taken from the lung cavity during the post mortem examination. It is suggested that if nocardiosis enters the differential diagnosis all specimens should be cultured for at least two weeks and the use of selective media be considered. This case highlights the need for clinicians to maintain a high index of suspicion for this pathogen. Departnent of Genitourinary Medicine, St Mary's Hospital, London W2 INY R J Coker P Horner D Tomlinson J Weber Department of Microbiology G Bignardi M Savage Department of Histopathology T Cook Correspondence to: Dr R J Coker Accepted for publication 16 February 1992 Nocardia asteroides infection affects mainly debilitated or immunocompromised patients. However, N asteroides seems to be a rare pathogen in patients with AIDS. There have been 14 cases reported in English.' The treatment of choice is generally considered to be prolonged administration of a sulphonamide, though which one varies. Unfortunately adverse reactions to sulphonamides, particularly co-trimoxazole, occur in about 65% of such patients taking them for Pneumocystis carinii pneumonia (PCP), and in 20-25% of such patients these drugs have to be dis-