Signs and symptoms
Pulmonary infection

Produces a virulent form of pneumonia (progressive)
Night sweats, fever, cough, chest pain
Pulmonary nocardiosis is subacute in onset and refractory to treatment with standard antibiotics
Symptoms are more severe in immunocompromised individuals
Radiologic studies show multiple pulmonary infiltrates, with a tendency to central necrosisNeurological infection

Headache, lethargy, confusion, seizures, sudden onset of neurological deficit
CT scan shows cerebral abscess
Nocardial meningitis is difficult to diagnoseCardiac conditions

Nocardia has been highly linked to endocarditis as a main manifestation
In recorded cases, it has caused damage to heart valves whether natural or prostheticLymphocutaneous disease

Nocardial cellulitis is akin to erysipelas but is less acute
Nodular lymphangeitis mimics sporotrichosis with multiple nodules alongside a lymphatic pathway
Chronic subcutaneous infection is a rare complication and osteitis may ensue
May be misidentified and treated as a staph infection, specifically superficial skin infections
Cultures must incubate more than 48 hours to guarantee an accurate testOcular disease

Very rarely, nocardiae cause keratitis
Generally there is a history of ocular traumaDisseminated nocardiosis

Dissemination occurs through the spreading enzymes possessed by the bacteria
Disseminated infection can occur in very immunocompromised patients
It generally involves both lungs and brain
Fever, moderate or very high can be seen
Multiple cavitating pulmonary infiltrates develop
Cerebral abscesses arise later
Cutaneous lesions are very rarely seen
If untreated, the prognosis is poor for this form of disease

Causes
Normally found in soil, these organisms cause occasional sporadic disease in humans and animals throughout the world. Another well publicized find is that of Nocardia as part of the oral microflora. Nocardia spp.
have been reported in the normal gingivae and periodontal pockets along with other species such as Actinomyces, Arthromyces and Streptomyces spp.The usual mode of transmission is inhalation of organisms suspended in dust. Another very common method is by traumatic introduction, especially in the jaw. This leads to the entrance of Nocardia into the blood stream and the propagation of its pathogenic effects. Transmission by direct inoculation through puncture wounds or abrasions is less common. Generally, nocardial infection requires some degree of immune suppression.A weakened immune system is a general indicator of a person who is more susceptible to nocardiosis, such as someone who already has a disease that weakens their immune system. Additionally, those with low T-cell counts or other complications involving T-cells can expect to have a higher chance of becoming infected. Besides those with weak immune systems, a local traumatic inoculation can cause nocardiosis, specifically the cutaneous, lymphocutaneous, and subcutaneous forms of the disease. There is no racial pattern in the risk of becoming infected with Nocardiosis. Diagnosis
Diagnosis of nocardiosis can be made by a doctor using various techniques. These techniques include, but are not limited to: a chest x-ray to analyze the lungs, a bronchoscopy, a brain/lung/skin biopsy, or a sputum culture. However, diagnosis may be difficult. Nocardiae are gram positive, weakly acid-fast, branching rod-shaped bacteria and can be visualized by a modified Ziehl–Neelsen stain such as the Fite-Faraco method.