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Reviewers: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 2 February 2012, last major update September 2011
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

Clinical features

● Ubiquitous saphrophyte; disease caused by inhalation or direct implantation into skin
● More than 30 species with clinical significance (Clin Microbiol Rev 2006;19:259)
● Opportunistic lung infection associated with transplantation, chemotherapy, immunosuppression, steroids
● Disease is relatively uncommon in HIV likely due to sulfonamide prophylaxis directed against P. jeroveci; HAART treatment may be effective (Can J Infect Dis Med Microbiol 2009;20:e103)
● Complication of alveolar proteinosis

Clinical images

White colonies

Gross images


Micro description

● Focal bronchopneumonia with microabscesses, variable histiocytic response and ill-defined granulomas
● If identified by anatomic pathologist, clinical microbiology laboratory should be notified as routine culture may not isolate the organism

Micro images

Small abscess

Nocardia brasiliensis

Gram stain

Modified acid fast stain shows weakly acid fast branching, filamentous bacilli

Modified Fite stain

Positive stains

● Modified acid fast, Fite, gram stain and GMS
Gram stain: slender, slightly beaded, branching filamentous bacilli

End of Lung-nontumor > Infections > Nocardia

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