Nocardia spp are a Gram-positive aerobic bacteria found commonly in soil and decaying vegetation. They enter the body through contamination of wounds or by inhalation.
Nocardia spp is an opportunistic acid-fast actinomycete that may cause disseminated disease, particularly in immunocompromised dogs.
Male, large-breed dogs kept outdoors were overrepresented.
Species pathogenic to dogs include:
- Nocardia asteroides
- Nocardia farcinica
- Nocardia cyriacigeorgica
- Nocardia abscessus
- Nocardia otitidiscaviarum
In dogs, a number of presentations are observed: systemic, central nervous system, extrapulmonary, cutaneous and actinomycetoma. The pulmonary form involves only the lungs, the systemic form involves two or more body sites and the extrapulmonary is any primary focus without involvement of the lung and central nervous system. Actinomycetoma is a distinct subcutaneous nodule.
Clinically affected dogs with cutaneous forms present with subcutaneous lesions, mycetomas, and lymphadenitis. Nocardial stomatitis manifests as gingivitis and ulceration of the oral cavity, with severe halitosis.
In the disseminated form, pyothorax and osteomyelitis are commonly observed, but systemic nocardiosis has also been recorded in immunosuppressed dogs such as those receiving long-term administration of cyclosporin or in dogs co-infected with distemper virus.
Diagnosis is based on bacterial culture or PCR identification and speciation
Nocardia spp appear to be resistant to many fluoroquinolones, and aggressive drainage of chest fluids and use of amoxycillin/clavulanate, amikacin, gentamicin, ceftiofur or trimethoprim-sulfamethoxazole often provide a good response to therapy.
Although systemic nocardial infections traditionally have had a grave prognosis, through early diagnosis, surgical intervention, and the use of newer, safer and synergistically acting antimicrobials, the prognosis has improved.
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