Journal of Diagnostics Concepts & Practice >

2026 , Vol. 25 >Issue 04: 476 - 482

DOI: https://doi.org/10.16150/j.1671-2870.2026.04.011

Review articles

Advances and challenges in diagnostic techniques for nocardiosis

  • WANG Shiyang ,
  • CHEN Qi ,
  • LIU Wenjing ,
  • CHEN Ruxuan ,
  • SUN Hongli ,
  • SHAO Chi ,
  • HUANG Hui
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  • a. Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
    b. Department of Medical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China

Received date: 2025-12-21

  Revised date: 2026-01-09

  Accepted date: 2026-03-04

  Online published: 2026-08-31

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Abstract

Nocardiosis is an opportunistic infectious disease caused by Nocardia species in humans, with diverse clinical manifestations. It commonly affects the lungs and skin/soft tissues, but can also present as disseminated infection involving the central nervous system and other sites. The disease has a high mortality rate (26% on average). As the population of immunosuppressed individuals continues to grow, the incidence of nocardiosis has been increasing year by year. Due to the slow growth of Nocardia and the lack of specific morphological features, traditional culture and microscopic examination have limitations in clinical diagnosis, such as low detection rates and long turnaround times, which may lead to misdiagnosis or delayed diagnosis. In addition, Nocardia species differ in geographic distribution, common sites of infection, and antimicrobial resistance profiles. In recent years, significant progress has been made in the diagnosis of nocardiosis, driven by advances in molecular biology and high-throughput detection technologies. Techniques targeting 16S rRNA and multilocus sequence analysis have improved the accuracy of species identification and have also revealed various resistance genes associated with resistance phenotypes in antimicrobial susceptibility testing. Metagenomic next-generation sequencing (mNGS) helps improve detection positivity rates and diagnostic speed, while also enabling the effective identification of multiple pathogens in polymicrobial infections. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), with increasingly comprehensive databases, can achieve faster and more cost-effective routine identification compared to molecular detection techniques. Combining traditional diagnostic methods with molecular techniques and rapid mass spectrometric identification in a complementary manner, and selecting appropriate diagnostic methods based on the urgency and severity of the patient's condition and the testing capabilities of the medical institutions may further improve the accuracy and timeliness of nocardiosis diagnosis, ultimately leading to improved patient outcomes.

Key words： Nocardiosis; Diagnostic techniques; Metagenomic next-generation sequencing; Antimicrobial susceptibi-lity testing

Cite this article

WANG Shiyang , CHEN Qi , LIU Wenjing , CHEN Ruxuan , SUN Hongli , SHAO Chi , HUANG Hui . Advances and challenges in diagnostic techniques for nocardiosis[J]. Journal of Diagnostics Concepts & Practice, 2026 , 25(04) : 476 -482 . DOI: 10.16150/j.1671-2870.2026.04.011

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