Nocardia spp. infections in immunocompetent children and adolescents treated at three healthcare institutions, 2006–2022 in Uruguay.

Abstract

Introduction: Nocardiosis is uncommon in pediatric populations, particularly in immunocompetent children, whom it manifests as a localized skin infection following trauma or exposure of a wound to organic matter. Diagnosis may be delayed due to nonspecific symptoms and low clinical suspicion. Objective: To describe a series of cases of nocardiosis in immunocompetent children treated at three healthcare centers in Montevideo, Uruguay, over 17 years. Methods: A descriptive study of previously healthy children under 15 years of age with confirmed Nocardia spp. infection between 2006 and 2022. Results: Eleven cases were identified. The median age was 5 years; 63% were male. Clinical presentations included abscesses, cellulitis, and osteomyelitis. Five had a history of trauma, and four had come in contact with the ground. The lower limbs were the most affected. Four cases presented with regional adenitis, and three developed a fever. All cases yielded cultures positive for Nocardia spp., with the species identified by MALDI-TOF MS in three of them. All patients were administered cotrimoxazole and had a favorable prognosis. Conclusions: Nocardiosis must be included in the differential diagnosis of subacute skin infections in immunocompetent children with a history of trauma or environmental exposure. Microbiological confirmation is essential, as the isolation of Nocardia spp. requires an assessment for potential immunodeficiency.