Nocardiosis in HIV-positive patients: an autopsy study in West Africa

Tuber Lung Dis. 1994 Aug;75(4):301-7. doi: 10.1016/0962-8479(94)90137-6.

Abstract

Background: There are many reports of nocardiosis associated with HIV infection in industrialized and developing countries, but its true prevalence is unknown.

Materials and methods: An autopsy study was performed of HIV-positive and HIV-negative patients dying on the general medical wards of a large hospital in Abidjan, Ivory Coast, in 1991.

Results: 247 HIV-positive adult cadavers were examined. 10 (4%) had nocardiosis of the lung, of whom 6 showed disseminated disease. 8 patients had one or more AIDS-defining pathologies, and 5 had nocardiosis as the main cause of death. Pulmonary tuberculosis was found in 87 cadavers (35%), giving a ratio of pulmonary nocardial to tuberculous disease of 1:9. No nocardiosis was seen in 42 HIV-negative cadavers.

Conclusions: This is the highest recorded prevalence of HIV-associated nocardiosis in a representative sample. The prevalence of nocardiosis varies geographically, and in zones where HIV-associated tuberculosis is common, it is possible that some patients diagnosed as smear-negative pulmonary tuberculosis actually have nocardiosis. A revised strategy of sputum examination with gram stain is suggested to detect nocardia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / diagnosis
  • AIDS-Related Opportunistic Infections / pathology
  • Adult
  • Autopsy
  • Diagnosis, Differential
  • HIV Seropositivity / complications*
  • Humans
  • Male
  • Middle Aged
  • Nocardia Infections / complications*
  • Nocardia Infections / diagnosis
  • Nocardia Infections / pathology
  • Nocardia asteroides*
  • Tuberculosis, Pulmonary / diagnosis