Nocardiosis: Causes, Symptoms, and Treatment
Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Nocardiosis?
An infectious disease doctor, a doctor who treats infections caused by germs, usually leads care for nocardiosis. A pulmonologist, a lung doctor, may help when the lungs are involved. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is nocardiosis?
Nocardiosis is an infection caused by Nocardia, a type of bacteria found in soil. It can affect the lungs, brain, and skin. It is most common in people with weakened immune systems. A weakened immune system means the body has a hard time fighting germs. In the United States, about 500-1,000 new cases happen each year.
Symptoms
Symptoms depend on which part of the body is infected. Some people have no symptoms. A lung infection can cause:
- Fever.
- Weight loss.
- Night sweats.
- Cough.
- Chest pain when breathing.
- Coughing up blood.
If the infection reaches the brain, symptoms can include headache, weakness, confusion, and seizures. A skin infection can cause ulcers, which are open sores, and nodules, which are growths under the skin. Sometimes the nodules drain when the infection spreads to the lymph nodes.
Causes and who gets it
Nocardia bacteria are found in soil, standing water, and decaying plants. You can get the infection by breathing in dust that has the bacteria. You can also get it when soil or water with the bacteria gets into a cut or open wound. Farming or gardening without gloves and protective clothing raises the risk of cuts and other small injuries. You are more likely to get nocardiosis if you have long-term lung disease or a weakened immune system. Conditions that can weaken the immune system include diabetes, cancer, HIV/AIDS, alcoholism, and an organ or bone marrow transplant. Taking high doses of drugs called corticosteroids also raises the risk. Men get nocardiosis more often than women. For every woman who gets it, about 3 men do.
How doctors diagnose it
Doctors diagnose nocardiosis with lab tests that look for the bacteria. These include a Gram stain, a modified acid-fast stain, or a culture. A culture grows the germ from a sample. For a lung infection, the test may be a sputum culture, which uses mucus coughed up from the lungs. Depending on the body part, a doctor may take a tissue sample. This is called a biopsy. It can come from the lung, skin, or brain. The germ can grow slowly. Routine cultures must be held for at least 14 days. Lab tests also show which type of Nocardia is causing the infection.
Treatment
Nocardiosis is treated with commonly available antibiotics. These are medicines that kill bacteria. You may need more than one antibiotic. Treatment often lasts 6 months to a year or longer. Some types of Nocardia resist certain antibiotics. So lab tests are used to choose the right medicine. Surgery may be done to drain an abscess, which is a pocket of pus. How well a person does depends on overall health and the parts of the body involved. An infection that affects many areas of the body is hard to treat.
When to see a doctor
Contact your provider if you have any symptoms of this infection. The symptoms are not specific and can have many other causes. Nocardiosis needs treatment. Without it, the infection can spread to other parts of the body, including the spinal cord and the brain. Call 911 or go to the emergency room if you have trouble breathing, chest pain or discomfort lasting two minutes or more, coughing up blood, a seizure, fainting, or a sudden change in mental state such as confusion.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either can review your symptoms and order first tests. They can also refer you to an infectious disease doctor and help with follow-up during long antibiotic treatment.
Common questions
How do you get nocardiosis?
You get nocardiosis by breathing in dust that has Nocardia bacteria. You can also get it when soil or water with the bacteria gets into a cut or open wound.
Can nocardiosis be treated?
Yes, nocardiosis is treated with commonly available antibiotics. Treatment can last several months or longer. Surgery may be needed to drain an abscess.
Who is most at risk for nocardiosis?
People with very weak immune systems have a higher risk. This includes people who have had an organ or bone marrow transplant.
Can people lower their risk of nocardiosis?
Yes, people with a weakened immune system can take steps when working in soil. They should wear shoes and gloves, wear clothing that covers the skin, and bandage open wounds and cuts.
Is nocardiosis serious?
Yes, it can be serious. CDC says the infection can be fatal in as many as 4 out of 10 cases. How well a person does depends on overall health and the parts of the body involved.
Sources
- MedlinePlus - Nocardia infection
- Centers for Disease Control and Prevention - About Nocardiosis
- Centers for Disease Control and Prevention - Clinical Overview of Nocardiosis
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
