Infections pulmonaires à Nocardia

Nocardial pneumonias are due to a genus of aerobic, filamentous, partly acid-alcohol fast, mainly Gram positive, actinomycetes.We report here two cases of nocardial pneumonia. The first was a 62 year old man with a history of fludaribine treatment and bone marrow transplant for lymphocytic leukaemia. During the investigation of pyrexia evidence of N. farcinica infection was found in the bronchial secretions. The second case was a man of 61 receiving long term corticosteroids and cytotoxic chemotherapy. Investigation of a pneumonia with pleural effusion found evidence, on culture of blood and pleural fluid, of disseminated infection with N. nova (cerebral, pleural, pulmonary and splenic).Nocardiosis is a rare cause of pneumonia mainly occurring in immuno-compromised adults (corticosteroid therapy, HIV infection, transplantation, cancer or leukaemia). It should be suspected in the presence of pleuro-pulmonary symptoms associated with neurological and cutaneous signs, general deterioration and weight loss. The microbiology laboratory should be advised of this eventuality as soon as possible in order to optimise the search for the organism.