Characteristics of Nocardia infection, which occurred in ten Oklahoma children between 1975 and 1980, are described. Fatal N asteroides infection occurred in three immunocompromised patients. Pneumonia was the presenting feature in each; one patient had disseminated disease. The first reported case of shunt-associated N asteroides ventriculitis occurred in a 2-month-old girl, who was successfully treated with oral trimethoprim-sul-famethoxazole. N brasiliensis was isolated from six immunologically competent children, five of whom had localized, uncomplicated, cutaneous infections. The sixth child developed osteomyelitis following a compound skull fracture. Based on this experience and a review of the literature, N asteroides infections are associated with immunocompromised hosts, and usually are seen as pneumonia with occasional dissemination to other sites. In contrast, N brasiliensis infections are more common than previously thought and usually occur in otherwise normal children as acute posttraumatic pyoderma.