Prognosis

Prognosis differs for patients with pulmonary, disseminated, and primary cutaneous nocardiosis. After treatment is started, clinical improvement should be evident within 7 to 10 days. Lack of response to initial therapy can be related to resistant species, subtherapeutic drug concentrations, inadequate penetration of the antibiotics into the infection site (such as central nervous system [CNS] infection), or a high burden of infection requiring surgical drainage or debridement.[20][93]​​​ The disease has a tendency to recur, and exacerbations can occur even during maintenance therapy if antibiotic concentrations are not optimal.[24]

Mortality

Mortality due to pulmonary nocardiosis ranges from 14% to 40%.[21] Mortality is not significantly increased for patients with disseminated disease not involving the CNS.[21] However, <40% of patients with disseminated disease and neurological involvement are treated successfully. Mortality remains higher among immunocompromised patients with multiple brain abscesses.[20] Although most cutaneous lesions and mycetomas are treated successfully medically, some cases may require surgery.[80][81] Almost all patients with primary cutaneous lesions are treated successfully.[20]

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