Clinical profile and outcomes of pulmonary nocardiosis in India: a systematic review of individual cases

Abstract

Introduction: Nocardiosis is a common cause of pneumonia in immunocompromised individuals. Limited data regarding its epidemiology, clinical presentations, and outcomes in India are available. This systematic review analysed the clinical profile and outcomes of pulmonary nocardiosis in India. Methods: We systematically reviewed individual cases of culture-confirmed pulmonary nocardiosis from India published between January 1960 and May 2024 using the PubMed, Embase, and Web of Science databases. Studies lacking microbiological confirmation or detailed clinical data were excluded. Descriptive statistics were used to summarise demographic, clinical, and microbiological data, while chi-square and t-tests assessed differences between mortality and survival groups. Results: The review included 109 cases from 67 stud-ies. Male predominance (74.1%) was observed, with a mean age of 49.6 ± 16.9 years. Diabetes (26.6%), steroid use (51.4%), and chronic lung disease (37.8%) were key risk factors. Nocardia otitidiscaviarum (38.4%) was the most common species identified. Mortality was noted in 26% of the patients. Cotrimoxazole resistance and lack of cotrimoxazole use for treatment were associated with mortality. Conclusions: Pulmonary nocardiosis presents diagnostic and therapeutic challenges in India, with high resistance rates and significant mortality. Improved diagnostic methods and region-specific treatment strategies are essential.