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Nocardia species are ubiquitous, environmental, Gram-positive bacteria belonging to the Actinomycetaceae family. Immunocompromised hosts such as recipients of solid organ and hematopoietic stem cell transplants are more susceptible to infection, and the most commonly affected organ is the lung. The net state of immunosuppression is an important risk factor for development of infection in transplant recipients. Isolation of Nocardia spp. in culture from a clinically suspected site of infection is sufficient for the diagnosis. As part of the evaluation, disease involvement of the central nervous system should always be ruled out with imaging even if no neurological symptoms are present. Successful treatment entails reduction of immunosuppression and months of antimicrobial therapy guided by antimicrobial susceptibility testing. The use of combination antimicrobials and surgical debridement may be warranted in select circumstances, in particular central nervous system disease. In transplant recipients, myelosuppression and nephrotoxicity are important treatment-associated toxicities and warrant close monitoring and potential adjustment of therapy. Although trimethoprim-sulfamethoxazole (TMP-SMX) has proven in vitro and in vivo activity against Nocardia spp., its use as prophylaxis for Pneumocystis jirovecii pneumonia should not be considered efficacious against Nocardia infection in transplant recipients.

DOI: 10.1007/978-3-030-01751-4_18-1