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Organism
- Gram positive rods
- true branching
- weakly acid fast
- Organisms found throughout the lesion
- Normal blood agar 2-4 days
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Epidemiology
- Ubiquitous in environment
- Inhalation - pulmonary disease
- skin lesion - skin pathology
- Mostly immunosuppressed patients
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Pathogenesis
- No specific virulence factors
- Dissemination to brain may occur
- Pulmonary, brain infections - N. Asteroides
- Skin infections: min trauma, N Brasiliensis
- Immunity: T-cell mediated immunity
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Manifestations
- Pulmonary: confluent bronchopneumonia; acute, chronic, relapsing; cavitation and extension to pleura; neurological lesions
- Cutaneous: pustule, fever, tender lymphadenitis
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Diagnosis
- Gram stain
- Acid fastness
- Large numbers in lesions make for easy diagnosis
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Treatment
- Sulfonamides
- Resistant to penicillin
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