Redefining the diagnostic pathway for pulmonary nocardiosis: The imperative for early metagenomic sequencing

doi:10.4329/wjr.v18.i2.119080

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Feb 28, 2026 (publication date) through Feb 28, 2026

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World Journal of Radiology

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1949-8470

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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©Author(s) (or their employer(s)) 2026. No commercial re-use. See Permissions. Published by Baishideng Publishing Group Inc.

World J Radiol. Feb 28, 2026; 18(2): 119080
Published online Feb 28, 2026. doi: 10.4329/wjr.v18.i2.119080

Redefining the diagnostic pathway for pulmonary nocardiosis: The imperative for early metagenomic sequencing

Tarun Kumar Suvvari, Ruchita Kodakandla, Venkataramana Kandi

Tarun Kumar Suvvari, Department of Clinical Research, Squad Medicine and Research, Amadalavalasa 532185, Andhra Pradesh, India

Ruchita Kodakandla, Department of Medicine, BronxCare Health System, New York, NY 10457, United States

Venkataramana Kandi, Department of Microbiology, Prathima Institute of Medical Sciences, Karimnagar 505417, Telangāna, India

Co-corresponding authors: Tarun Kumar Suvvari and Venkataramana Kandi.

Author contributions: Suvvari TK and Kodakandla R contributed to conceptualization, supervision, resource provision; Kandi V contributed to project administration; Suvvari TK and Kandi V contributed equally to this article, they are the co-corresponding authors of this manuscript; Suvvari TK, Kodakandla R, and Kandi V contributed to the study idea formal analysis, manuscript drafting and editing, and approved the final draft; and all authors thoroughly reviewed and endorsed the final manuscript.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Corresponding author: Tarun Kumar Suvvari, Department of Clinical Research, Squad Medicine and Research, First Floor, SMR Main Office, 17-2-49/2, Vengalarao Colony, Amadalavalasa 532185, Andhra Pradesh, India. drtarunsuvvariresearch@gmail.com

Received: January 19, 2026
Revised: February 4, 2026
Accepted: February 24, 2026
Published online: February 28, 2026
Processing time: 38 Days and 1.2 Hours

Core Tip

Core Tip: The large-scale study by Wang et al defines key computed tomography patterns that predict pulmonary nocardiosis. This article argues these imaging findings should trigger an immediate diagnostic shift, positioning metagenomic next-generation sequencing as a primary, not secondary, tool. A new algorithm integrating radiologic triage with rapid metagenomic next-generation sequencing testing can dramatically reduce diagnostic delay, enabling faster targeted treatment.