Nocardiosis: Symptoms, Diagnosis, Treatment, and Prognosis of Nocardia Infection

Nocardiosis is a rare but potentially serious bacterial infection caused by bacteria of the genus Nocardia. These organisms live in soil, standing water, decaying plant matter, and organic material, and humans are usually infected by inhaling contaminated dust or by inhaling the bacteria through a cut, abrasion, thorn prick, or wound.[1]

Nocardia is not a fungus, although it may appear as thin, branching threads under a microscope. These are aerobic, partially acid-fast, gram-positive bacteria that can cause both localized skin infections and severe damage to the lungs, brain, soft tissue, bones, kidneys, and other organs. [2]

Nocardiosis most often begins as a pulmonary infection, as inhalation of contaminated dust is considered one of the main routes of transmission. However, the disease can mimic tuberculosis, bacterial pneumonia, fungal infection, tumor, or exacerbation of chronic lung disease, so diagnosis is often delayed. [3]

A particular danger of nocardiosis is the ability of Nocardia to spread through blood. The US Centers for Disease Control and Prevention (CDC) notes that most patients present with invasive pulmonary infection, disseminated infection, or brain abscess, with central nervous system involvement associated with particularly high mortality. [4]

Modern treatment of nocardiosis requires not only antibiotic administration but also accurate identification of the Nocardia species, determination of susceptibility to drugs, identification of foci of transmission, and long-term monitoring. A 2025 review in Clinical Infectious Diseases emphasizes that the optimal duration of therapy has not been adequately studied, and treatment is often selected based on severity, location, bacterial species, and susceptibility testing results. [5]

Key point	What is important to know
Pathogen	Bacteria of the genus Nocardia
Where do bacteria live?	Soil, standing water, decaying plants
The main routes of infection	Inhalation of dust, contaminated soil or water getting into the wound
Frequent localizations	Lungs, skin, brain
Main risk groups	Immunodeficiency, transplantation, high doses of corticosteroids, chronic lung diseases
Main diagnostics	Culture, microscopy, molecular identification, susceptibility testing
The basis of treatment	Long-term antibiotics, sometimes surgical drainage

The pathogen and its characteristics

The genus Nocardia includes many clinically significant species: The US Centers for Disease Control and Prevention indicates that more than 40 species of Nocardia are considered significant to humans, and commonly reported species include Nocardia nova, Nocardia farcinica, Nocardia cyriacigeorgica, Nocardia brasiliensis, and Nocardia abscessus.[6]

For clinicians, the Nocardia species is of practical importance because different species differ in their predisposition to specific forms of the disease and their sensitivity to antibiotics. For example, Nocardia brasiliensis is more often associated with cutaneous forms, while Nocardia farcinica is particularly important due to its tendency to spread and its drug resistance. [7]

Nocardia grows slowly, so routine cultures may not immediately become positive. The U.S. Centers for Disease Control and Prevention recommends that routine cultures for suspected Nocardia be kept for at least 14 days, otherwise the infection may be missed. [8]

Under microscopy, Nocardia may appear as branching "bead-like" threads that partially retain staining under special acid-fast staining techniques. This helps suggest a diagnosis, but precise species identification usually requires molecular methods or modern laboratory systems. [9]

Modern laboratory diagnostics are gradually improving. A 2024 study showed that matrix-assisted laser desorption ionization mass spectrometry with time-of-flight analysis can quickly and reliably identify many Nocardia isolates with an updated database and proper sample preparation, but complex cases still require sequencing. [10]

Species or group	Clinical significance
Nocardia farcinica	Often resistant to multiple antibiotics, can spread
Nocardia brasiliensis	Often associated with cutaneous nocardiosis
Nocardia cyriacigeorgica	A common clinical presentation in pulmonary infections
Nocardia nova	One of the common clinical types
Nocardia abscessus	May cause pulmonary and other forms
Several species of Nocardia	They differ in sensitivity to antibiotics
Accurate identification	Needed for choosing therapy and prognosis

Epidemiology and risk groups

Nocardiosis occurs worldwide, but precise incidence rates are limited because the infection is rare and not always quickly recognized. The U.S. Centers for Disease Control and Prevention estimates that approximately 500-1,000 new cases of nocardiosis occur in the United States each year, and about 60% of cases are associated with preexisting immune deficiency.[11]

The incidence is likely increasing or being better identified due to the increasing number of people with severe immunodeficiency, transplants, cancer, and long-term immunosuppressive therapy. The CDC specifically states that the increase in cases may be due to the increasing number of people with severe immune impairment. [12]

Classic risk factors include organ or bone marrow transplantation, cancer, human immunodeficiency virus-associated severe immune deficiency, diabetes mellitus, chronic lung disease, pulmonary alveolar proteinosis, connective tissue diseases, alcohol abuse, and high-dose corticosteroid use.[13]

Men are more likely to get the disease than women: the CDC reports a rate of approximately 3 cases in men for every 1 case in women. Reasons for this difference may include different occupational exposures, underlying medical conditions, behavioral factors, and immune response characteristics, but the practical conclusion is the same: unexplained pneumonia in men with chronic lung disease or immunodeficiency should be of greater concern. [14]

Nocardiosis can also occur in people without obvious immunodeficiency. The MSD Manual notes that up to 40% of patients with nocardiosis have no detectable immune disorder, so a normal immune status does not rule out the diagnosis, especially in cases of skin infection following soil-borne trauma or atypical protracted pneumonia. [15]

Risk group	Why is the risk higher?
Organ transplantation	Immunosuppressive therapy reduces bacterial control
Bone marrow transplant	High risk of late opportunistic infections
High-dose corticosteroids	Suppress cellular immunity
Chronic lung disease	Facilitates pulmonary colonization and infection
Diabetes mellitus	Disrupts the immune response and tissue healing
Oncological diseases	Risk due to illness and treatment
Contact with soil in wounds	Increases the risk of cutaneous nocardiosis

How does infection occur?

The main routes of infection are inhalation of dust containing Nocardia and direct ingestion of bacteria through a break in the skin. The CDC describes three typical scenarios: a person inhales dust containing the bacteria, contaminated soil or water gets into a cut, or the bacteria enter a surgical wound through contaminated medical equipment, although hospital-acquired outbreaks are rare. [16]

Pulmonary nocardiosis develops after bacteria enter the respiratory tract. In a healthy person, local defense mechanisms can cope with the bacteria, but in cases of chronic lung disease, corticosteroid therapy, transplantation, or other immune compromise, Nocardia can become established, multiply, and cause pneumonia, abscesses, or cystic lesions. [17]

Cutaneous nocardiosis is often associated with trauma: a thorn prick, scratch, cut, contaminated soil, or ungloved agricultural or gardening work. The CDC notes that working with soil without protective clothing increases the risk of cuts, punctures, and other minor injuries through which Nocardia can enter the skin. [18]

Human-to-human transmission is not considered a common route. The MSD Manual states that human-to-human and animal-to-human transmission is unknown, so nocardiosis is not considered a typical contagious infection in the community sense. [19]

After the initial infection, bacteria can spread through the bloodstream. The brain is a particularly important site of dissemination: the CDC notes that in disseminated nocardiosis, the brain is the most common site of involvement, necessitating an active search for neurological complications. [20]

Route of infection	Typical form
Inhalation of contaminated dust	Pulmonary nocardiosis
Soil getting into the cut	Cutaneous or subcutaneous nocardiosis
Spread by blood	Damage to the brain, skin, bones, kidneys and other organs
Contamination of the surgical wound	Rare medically associated infection
Household contact with a sick person	Normal transmission is not proven
Working with the earth without protection	Risk of skin infection
Chronic lung disease	Risk of pulmonary infection and colonization

Forms of nocardiosis

Pulmonary nocardiosis is the most common form. It can present as subacute or chronic pneumonia with cough, fever, chest pain, weakness, loss of appetite, weight loss, pulmonary abscesses, nodules, infiltrates, or cystic lesions.[21]

Cutaneous nocardiosis develops after bacteria enter broken skin. It can present as dense, painful cellulitis, subcutaneous nodules, abscesses, ulcers, purulent fistulas, or a lymphocutaneous form similar to sporotrichosis, in which nodules form in a chain along the lymphatic vessels. [22]

Actinomycetoma caused by Nocardia is a chronic, destructive infection of the skin, subcutaneous tissue, fascia, and sometimes bone. It begins as a nodule, then suppurates, spreads through the tissues, and can form chronic sinus tracts with purulent discharge. [23]

Disseminated nocardiosis refers to the spread of infection beyond the primary site. It can affect the brain, skin, soft tissue, kidneys, bones, muscles, heart, and other organs. Therefore, if nocardiosis is confirmed, the physician should actively search for secondary lesions, even if the symptoms are limited to the lungs. [24]

Central nervous system nocardiosis most often presents with brain abscess, headache, weakness, confusion, seizures, or sudden focal neurological deficits. In patients after bone marrow transplantation, an international study showed frequent brain damage and recommended brain imaging even without neurological symptoms. [25]

Form	Main manifestations
Pulmonary	Cough, fever, chest pain, nodules, cavities, abscesses
Skin	Cellulitis, nodules, ulcers, abscesses
Lymphocytic	Nodes along the lymphatic vessels
Actinomycetoma	Chronic fistulas, soft tissue and bone lesions
Disseminated	Several organs, often the brain and skin
Central nervous system	Brain abscess, seizures, confusion, focal deficits
Severe systemic	Sepsis, respiratory failure, multiple foci

Symptoms

Symptoms of nocardiosis vary by location, so the disease does not have a single, "signature" symptom. The CDC describes the pneumonic form as an illness characterized by fever, weight loss, night sweats, cough, chest pain, and pneumonia, which can easily be confused with tuberculosis, common bacterial pneumonia, or tumor. [26]

When the lungs are affected, symptoms often develop slowly. The patient may complain of cough, weakness, low-grade or high fever, night sweats, chest pain, shortness of breath, and weight loss for weeks, and CT scans may reveal nodules, infiltrates, abscesses, cavities, and pleural effusions.[27]

The cutaneous form presents with painful redness, swelling, an ulcer, nodule, abscess, or chronic wound that does not heal well after contact with soil. The CDC recommends seeking medical attention for any non-healing injury or symptoms of nocardiosis, and be sure to report how the wound was acquired, as this information helps in making a proper diagnosis. [28]

Central nervous system involvement can manifest as headache, weakness, confusion, seizures, drowsiness, and impaired speech, vision, movement, or sensation. The CDC lists headache, lethargy, confusion, seizures, and sudden neurological deficits as symptoms of central nervous system involvement in nocardiosis. [29]

In people who have received a transplant, symptoms may be subtle. In a study of patients who received hematopoietic cell transplants, 36% of episodes were afebrile, and 33% of patients with brain damage had no neurological symptoms, demonstrating that in severely immunocompromised patients, the absence of overt symptoms does not preclude dangerous dissemination. [30]

Localization	Possible symptoms
Lungs	Cough, fever, chest pain, shortness of breath, weight loss
Leather	Ulcer, node, abscess, cellulitis, fistula
Lymphatic vessels	Chain of subcutaneous nodes
Brain	Headache, confusion, seizures, focal deficits
Bones and joints	Pain, swelling, limited movement
Dissemination	Fever, weakness, multiple lesions
Immunodeficiency	Symptoms may be subtle or atypical.

Diagnostics

Diagnosis of nocardiosis should always be confirmed by laboratory testing. The CDC specifically states that confirmation of nocardiosis should be accomplished by laboratory testing, and specimens may be collected from the lungs, sputum or lower respiratory tract material, skin, brain, or other affected area. [31]

The physician should alert the laboratory in advance of a suspected Nocardia infection. This is important because the bacterium grows slowly, and routine cultures must be maintained for at least 14 days; if the culture is dismissed as negative too early, the diagnosis may be missed. [32]

Primary microscopy helps quickly establish the diagnosis. Branching gram-positive filaments, which are partially acid-fast with modified staining, may be visible in specimens from sputum, bronchoalveolar lavage, abscesses, wounds, or tissue. [33]

Molecular methods are increasingly being used to accurately identify the species. The CDC states that accurate identification of the Nocardia species requires molecular methods and sometimes referral of the isolate to a reference laboratory for identification and antibiotic susceptibility testing. [34]

Diagnosis should include a search for dissemination. A 2025 review emphasizes that once diagnosed, patients are at risk for dissemination and require evaluation for possible secondary foci; in pulmonary nocardiosis, it is especially important to consider the brain, skin, and other organs. [35]

Method	What does it show?
Microscopy of material	Branching bacteria suspected of being Nocardia
Sowing	Confirms Nocardia growth
Long incubation	Needed due to slow growth
Molecular identification	Specifies the type
Sensitivity test	Helps choose an antibiotic
Computed tomography of the chest	Nodes, infiltrates, cavities, abscesses
Brain imaging	Looks for abscesses and other lesions

Differential diagnosis

Pulmonary nocardiosis must be distinguished from tuberculosis, nontuberculous mycobacteria, aspergillosis, bacterial pneumonia, lung cancer, metastases, inflammatory lung diseases, and exacerbation of chronic lung disease. A 2025 review emphasizes that pulmonary nocardiosis is particularly difficult to differentiate in patients with pre-existing chronic lung diseases, and the discovery of Nocardia in the respiratory tract may sometimes represent colonization rather than active infection. [36]

The key challenge is distinguishing infection from colonization. A recent review indicates that approximately 20% of patients with Nocardia growth in culture can be classified as colonized, so a complete clinical history, symptoms, and radiographic examination are needed, rather than just a positive sputum culture. [37]

Cutaneous nocardiosis resembles common bacterial cellulitis, furuncles, abscesses, sporotrichosis, cutaneous tuberculosis, atypical mycobacterial infections, fungal mycetoma, and skin tumors. Clues include contact with soil, a thorn puncture, chronicity, lymph nodes, and a poor response to standard antibiotics. [38]

Brain abscesses caused by Nocardia must be distinguished from metastases, toxoplasmosis, tuberculomas, fungal abscesses, bacterial abscesses of other origins, and lymphoma. In an immunocompromised patient, multiple lesions in the brain and lungs should prompt the physician to consider not only fungi and mycobacteria but also Nocardia. [39]

In transplant recipients and those with human immunodeficiency virus (HIV), nocardiosis may coexist with other infections. A 2026 review of the treatment of Nocardia in transplant recipients and those with human immunodeficiency virus (HIV) emphasizes that the clinical presentation is nonspecific, and concomitant opportunistic infections can complicate diagnosis. [40]

What is it compared to?	Why does it look like this?
Tuberculosis	Cough, weight loss, cavities in the lungs
Non-tuberculous mycobacteria	Chronic pulmonary changes
Aspergillosis	Nodes, cavities, immunodeficiency
Lung cancer	Node or infiltrate on tomography
Bacterial pneumonia	Temperature, cough, infiltrate
Sporotrichosis	Nodes along the lymphatic vessels
Toxoplasmosis of the brain	Foci in the brain in immunodeficiency

Treatment

Treatment for nocardiosis is usually lengthy because the bacteria can slowly multiply, form abscesses, and recur. The CDC states that patients may need multiple antibiotics for several months, sometimes up to 1 year or longer, and abscesses and wound infections sometimes require surgical drainage.[41]

The classic drug is a combination of sulfamethoxazole and trimethoprim. The MSD Manual describes it as the treatment of choice, but emphasizes that the dosage and duration depend on the extent of the infection, the immune status, and the location of the lesion. [42]

For severe, disseminated, or immunocompromised nocardiosis, combination therapy is often initiated. The MSD Manual recommends that in immunocompromised patients and for disseminated disease, a combination of sulfamethoxazole and trimethoprim is used with amikacin, imipenem, or meropenem until species and susceptibility testing is obtained. [43]

Antibiotic selection should be based on susceptibility testing. The CDC warns that Nocardia has species-specific susceptibility profiles, and multidrug-resistant strains are common; Nocardia farcinica, for example, can be resistant to several drugs, including sulfamethoxazole and trimethoprim. [44]

Linezolid is considered an important alternative or component of empirical therapy for moderate to severe nocardiosis, particularly when good oral bioavailability and central nervous system penetration are required. A study in Open Forum Infectious Diseases demonstrated 100% susceptibility of isolates to linezolid in their series and comparable outcomes with other regimens under controlled conditions, but the drug requires toxicity monitoring. [45]

Clinical situation	Frequent approach
Mild local cutaneous form	One active antibiotic after confirmation
Pulmonary form	Sulfamethoxazole and trimethoprim or combination according to severity
Disseminated form	A combination of several antibiotics
Brain damage	Drugs that penetrate the central nervous system, often in combination
Suspicion of Nocardia farcinica	The sensitivity test is especially important
Sulfonamide intolerance	Linezolid, amikacin, carbapenems, cephalosporins and other susceptibility variants
Abscess	Antibiotics and drainage as indicated

The duration of therapy is individualized. A 2025 review provides guidelines: pulmonary nocardiosis is often treated for about 6 months, cutaneous nocardiosis for about 3 months, and disseminated infection or central nervous system involvement for about 12 months, but these durations are based on limited data and should be adjusted based on patient response. [46]

Surgical treatment is not routine for every patient, but may be crucial for brain abscesses, soft tissue abscesses, empyemas, and mediastinal or pericardial fluid collections. The CDC indicates that surgery may be necessary for brain and soft tissue abscesses that do not respond to antibiotics, as well as when drainage of empyemas and other collections is necessary.[47]

When brain involvement is present, treatment must be particularly aggressive and multidisciplinary. A systematic review of cases of central nervous system nocardiosis concluded that the disease is associated with significant mortality, particularly in immunocompromised patients, and that a combination of surgical approach and antimicrobial therapy may improve outcomes. [48]

In transplant patients, it is important not only to kill the bacteria but also to carefully manage immunosuppression. A 2026 review emphasizes that treatment of nocardiosis in transplant recipients and those with advanced human immunodeficiency virus infection is complicated by drug interactions, drug toxicity, species-specific susceptibility variation, and a limited evidence base. [49]

New treatment methods today rely not on a single, universal "new antibiotic," but on more accurate diagnostics, rapid species identification, early detection of dissemination, therapeutic drug monitoring for toxic agents, and individualized regimens. This is particularly important because randomized trials of optimal treatment regimens for nocardiosis remain insufficient. [50]

Prevention

It is impossible to completely eliminate contact with Nocardia because these bacteria are widespread in the environment. Therefore, prevention is based not on maintaining a sterile environment, but on reducing the risk for people with immunodeficiency and on early treatment for suspicious symptoms. [51]

The CDC advises people with weakened immune systems to take protective measures when working with soil: wear shoes and gloves, cover skin with clothing, and cover open wounds or cuts with a bandage. This is especially important after transplants, with high doses of corticosteroids, cancer treatment, and other conditions that severely weaken the immune system. [52]

Transplant patients are sometimes prescribed prophylactic antibiotics to protect against opportunistic infections. The CDC notes that in people who have received an organ transplant, prophylactic antibiotics may reduce the risk of nocardiosis, and a 2024 systematic review and individual meta-analysis found that prophylaxis with sulfamethoxazole and trimethoprim in solid organ recipients likely reduces the risk of nocardiosis. [53]

Prophylaxis does not mean self-administration of antibiotics. The decision regarding prophylaxis is made by the physician, taking into account the type of transplant, the degree of immunosuppression, the risk of other infections, renal function, sulfonamide tolerance, drug interactions, and local protocols. [54]

Hospital-acquired outbreaks of nocardiosis are rare but possible. The CDC notes that some outbreaks have been linked to patients, health care workers, or airborne releases of bacteria during construction, so hospitals use infection control measures, especially around immunocompromised patients. [55]

Preventive measure	To whom is it especially important?
Gloves when working with soil	People with immunodeficiency
Closed clothing and footwear	In gardening and agricultural work
Bandage for cuts	In case of any contact with ground or water
Chronic lung disease control	Patients with bronchiectasis and chronic infections
Preventive antibiotics as prescribed	For selected patients after transplantation
Infection control in the hospital	Immunocompromised patients
Early screening for symptoms	For all risk groups

Forecast

The prognosis depends on the disease stage, immune status, speed of diagnosis, the Nocardia species, antibiotic susceptibility, and the presence of dissemination. Without treatment, pulmonary and disseminated nocardiosis can be fatal, but with proper therapy, outcomes improve significantly. [56]

Cutaneous localized nocardiosis in an immunocompetent patient usually has a better prognosis, especially if the lesion is diagnosed early, drained if necessary, and treated with an active antibiotic. However, actinomycetoma and chronic sinusoidal forms may require long-term treatment and sometimes surgery. [57]

Pulmonary nocardiosis carries a more serious prognosis, especially in people with chronic lung disease, transplantation, cancer, and long-term corticosteroid therapy. The CDC indicates that approximately 10% of cases of uncomplicated nocardiosis pneumonia are fatal, and when the brain or central nervous system is affected, the fatality rate can be much higher. [58]

Patients who have received hematopoietic cell transplants have particularly severe outcomes. In an international study of 81 cases of nocardiosis, 57% of infections were disseminated, 37% involved the brain, and the 1-year all-cause mortality rate was 40%. [59]

Relapse is possible even after treatment. A 2025 review indicates that approximately 5% of patients with nocardiosis experience relapse, so after completing therapy, the patient should be monitored, symptoms should be controlled, imaging should be repeated as indicated, and the persistence of immune risk should be considered. [60]

Factor	Impact on prognosis
Local cutaneous form	Usually better
Pulmonary form	The prognosis depends on immunity and spread
Brain abscess	Significantly worsens the prognosis
Dissemination	Increases the risk of death and relapse
Immunodeficiency	Worsens the outcome
Quick species identification	Improves treatment choice
Sensitivity test	Reduces the risk of ineffective therapy

FAQ

Is nocardiosis a fungal infection?
No. Nocardia may resemble a mushroom under a microscope due to its branching threads, but it is a bacterium, so treatment relies on antibacterial drugs rather than antifungal therapy. [61]

Can you become infected with nocardiosis from another person?
Routine person-to-person transmission is not considered a proven route. Infection is usually environmental: inhaling dust containing bacteria or ingestion of contaminated soil and water through broken skin. [62]

What organs does nocardiosis most commonly affect?
The lungs are most commonly affected, but the infection can spread to the brain, skin, soft tissue, kidneys, bones, muscles, and other organs. The CDC states that most cases present with invasive pulmonary infection, disseminated disease, or brain abscess. [63]

Why is nocardiosis often diagnosed late?
It's rare, the symptoms are nonspecific, similar to other infections and tumors, and Nocardia cultures grow slowly. Therefore, the laboratory must be alerted to the suspicion early enough to ensure the culture is maintained for a sufficiently long time. [64]

What tests confirm nocardiosis?
Diagnosis is confirmed by microscopy, culture of material from the affected organ, molecular identification of the species, and antibiotic susceptibility testing. Chest CT scans, brain imaging, and other symptom-based methods are used to assess dissemination. [65]

Why is it important to identify the Nocardia species?
Different species have different antibiotic susceptibility profiles. The CDC notes that multidrug-resistant strains are common, and Nocardia farcinica can be resistant to multiple drugs, so susceptibility testing is necessary for every clinically significant isolate. [66]

What is the most common treatment for nocardiosis?
The classic drug is a combination of sulfamethoxazole and trimethoprim, but for severe, disseminated, or resistant infections, combinations with amikacin, imipenem, meropenem, ceftriaxone, linezolid, and other drugs may be used based on susceptibility testing. [67]

How long does treatment last?
Treatment usually lasts for months: pulmonary nocardiosis is often treated for about 6 months, cutaneous nocardiosis for about 3 months, and disseminated infection or central nervous system involvement for about 12 months, although the exact duration depends on the response and immune status.[68]

When is surgery needed?
Surgery or drainage may be needed for brain abscess, soft tissue abscess, empyema, mediastinal or pericardial fluid collection, especially if antibiotics are not effective enough.[69]

Can nocardiosis be prevented?
It's impossible to completely prevent exposure to Nocardia, but it's important for people with weakened immune systems to protect their skin when working with soil, cover wounds, wear gloves and shoes, and, after transplantation, in some cases, a doctor may prescribe prophylactic antibiotics. [70]

Key points from experts

Zachary A. Yetmar, MD, Mayo Clinic, lead author of the 2025 review “Modern Approach to Nocardiosis”: Nocardiosis requires a multidisciplinary approach because the clinical manifestations are diverse, the risk of dissemination is high, and treatment must be adjusted according to the Nocardia species and susceptibility test results. [71]

US Centers for Disease Control and Prevention: If nocardiosis is suspected, routine cultures should be maintained for at least 14 days, accurate species identification requires molecular methods, and susceptibility testing should be performed on each clinically significant isolate.[72]

Denise M. Aaron, MD, Dartmouth Geisel School of Medicine, author of the professional review of the MSD Manual: Nocardiosis most often begins as a pulmonary infection but can spread to almost any organ; treatment is usually based on sulfamethoxazole and trimethoprim, and in severe cases requires a combination of drugs. [73]

Dina Averbuch, a physician and researcher of infections in patients after hematopoietic cell transplantation, and co-authors of an international study: In hematopoietic cell transplant recipients, nocardiosis often occurs late, typically affects the lungs, is frequently disseminated, frequently involves the brain, and is associated with high mortality. [74]

Dinesh S. Meena et al., systematic review of central nervous system nocardiosis: Central nervous system involvement in nocardiosis carries significant mortality, especially in immunocompromised patients, and the combination of surgical treatment with antibiotics may improve clinical outcome.[75]