Background: Nocardia, a gram-positive aerobic bacillus of the Actinomycetales family, is a significant opportunistic pathogen in immunocompromised individuals. Clinical and radiological features of pulmonary nocardiosis are nonspecific and can be misdiagnosed as tuberculosis, pneumocystis, staphylococcal or fungal infections, or as malignancy. Aspiration cytology with special stains is a quick and effective approach for accurate diagnosis. Materials and Methods: We present 7 cases of pulmonary nocardiosis, admitted to the pathology department in a tertiary-care hospital in Punjab. Clinical findings, immune status, laboratory tests, chest radiographs, and computed tomography scans were reviewed. Cytologically, special stains like 1% Ziehl-Neelsen (ZN), 20% ZN, periodic acid-Schiff (PAS), Grocott methenamine silver (GMS), and reticulin stains were studied along with May-Grünwald Giemsa, Papanicolaou, and hematoxylin and eosin. Results: All the patients were immunocompromised. The radiological changes were nonspecific. Cytomorphology showed acute and chronic inflammatory infiltrates with necrosis. None of the cases showed well-defined granulomas. GMS, modified 1% ZN and, Gordon and Sweet reticulin stains highlighted the delicate filamentous bacteria in all cases. PAS and 20% ZN stain for tuberculous bacilli were uniformly negative. Conclusion: FNAC can provide a quick and accurate diagnosis of nocardiosis and thereby facilitate timely medical management.

Keywords:
FNAC, Nocardia, Ziehl-Neelsen stain, Reticulin
1.
Kumar R, Chhina DK, Kaushal V, Mahajan R, Kaur H: Cytological diagnosis of pulmonary nocardiosis in an immunocompromised patient. Indian J Med Microbiol 2008; 26: 380–382.
2.
Martínez R, Reyes S, Menéndez R: Pulmonary nocardiosis: risk factors, clinical features, diagnosis and prognosis. Curr Opin Pulm Med 2008; 14: 219–227.
3.
Ambrosioni J, Lew D, Garbino J: Nocardiosis: updated clinical review and experience at a tertiary center. Infection 2010; 38: 89–97.
4.
Powers CN: Diagnosis of infectious diseases: a cytopathologist’s perspective. Clin Microbiol Rev 1998; 11: 341–365.
5.
Mathur S, Sood R, Aron M, Iyer V K, Verma K: Cytologic diagnosis of pulmonary nocardiosis: a report of 3 cases. Acta Cytol 2005; 49: 567–570.
6.
Corti ME, Fioti MF: Nocardiosis: a review. Int J Infect Dis 2003; 7: 243–250.
7.
Hannaman MJ, Ertl MJ: Patients with immunodeficiency. Med Clin North Am 2013; 97: 1139–1159.
8.
Leong KP, Tee NW, Yap WM, Chee TS, Koh ET; Nocardiosis in patients with systemic lupus erythematosus: the Singapore Lupus Study Group. J Rheumatol 2000; 27: 1306–1312.
9.
Shivaprakash MR, Rao P, Mandal J, Biswal M, Gupta S, Ray P, et al: Nocardiosis in a tertiary care hospital in North India and review of patients reported from India. Mycopathologia 2007; 163: 267–274.
10.
Yang M, Xu M, Wei W, Gao H, Zhang X, Zhao H, et al: Clinical findings of 40 patients with nocardiosis: a retrospective analysis in a tertiary hospital. Exp Ther Med 2014; 8: 25–30.
11.
Hui CH, Au VW, Rowland K, Slavotinek JP, Gordon DL: Pulmonary nocardiosis re-visited: experience of 35 patients at diagnosis. Respir Med 2003; 97: 709–717.
12.
Torres OH, Domingo P, Pericas R, Boiron P, Montiel JA, Vanquez G: Infection caused by Nocardia farcinica: case report and review. Eur J Clin Microbiol Infect Dis 2000; 19: 205–212.
13.
Sharma S, Singh P, Garg R, Dey P: Pulmonary nocardiosis in fine-needle aspiration cytology smears: report of four cases. Diagn Cytopathol 2016; 4: 347–350.
14.
McHugh KE, Sturgis CD, Procop GW, Rhoads DD: The cytopathology of Actinomyces, Nocardia, and their mimickers. Diagn Cytopathol 2017; 45: 1105–1115.
15.
Pollock PG, Valicenti JF Jr, Meyers DS, Frable WJ, Durham JB: The use of fluorescent and special staining techniques in the aspiration of nocardiosis and actinomycosis. Acta Cytol 1978; 22: 575–579.
16.
Woods GL, Walker DH: Detection of infectious agents by use of cytologic and histologic stains. Clin Microbiol Rev 1996; 9: 382–404.
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2018
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