To analyze the clinical features, etiological characteristics, antibiotic selection, and prognosis of patients with pulmonary nocardiosis, in order to provide evidence for its diagnosis and treatment.

The clinical data of patients with pulmonary nocardiosis diagnosed at the Anhui Chest Hospital from 2020 to 2023 were analyzed retrospectively.

Among 17 cases of nocardiosis included, all had symptoms of pulmonary infection. The most common underlying disease was chronic pulmonary disease (58.82%, 10/17), including bronchiectasis, chronic obstructive pulmonary disease, tuberculosis infection, and bronchitis asthma. The clinical manifestations were mainly cough, expectoration, and hemoptysis. Most of the imaging findings were bilateral lung involvement, mainly nodules and patchy shadows of varying sizes. Among the 17 cases of pulmonary nocardia infection, the most common pathogen was Nocardia cyriacigeorgica (n=9), followed by Nocardia otitidiscaviarum (n=2), Nocardia asiatica (n=1), Nocardia asteroides (n=1), Nocardia wallacei (n=1), and Nocardia farcinica (n=1). According to the results of drug sensitivity testing, nocardia had high sensitivity to linezolid and amicacin (100%), and low resistance to compound sulfamethoxazole (TMP-SMX), imipenem, and minocycline (9.09%). Of the 17 patients, 10 (58.82%) received monotherapy or combination therapy with TMP-SMX, and 88.24% achieved clinical efficacy.

Nocardia is prone to infect people with underlying lung diseases or low immunity, and the specificity of clinical symptoms and imaging findings is very low. Nocardia is mainly cultured in laboratory tests as the basis for clinical diagnosis, but its growth is slow. TMP-SMX is the preferred treatment for nocardiosis, and other drugs work better in combination with TMP-SMX.