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PubMed2004

Primary Nocardia brasiliensis of the eyelid.

PURPOSE: To report a rare case of lymphocutaneous Nocardia brasiliensis originating in the eyelid. DESIGN: Observational case report. METHODS: The clinical presentation, workup, and treatment of a case of lymphocutaneous Nocardia brasiliensis originating in the eyelid are presented. RESULTS: The patient presented with a preseptal cellulitis from an abrasion of the eyelid that progressed to submandibular lymph node suppuration. Culture was performed, and a diagnosis of lymphocutaneous Nocardia brasiliensis was made. CONCLUSION: Nocardia brasiliensis may cause a lymphocutaneous infection of the face and must be considered in the differential diagnosis of preseptal cellulitis.

Aged↗
PubMed2006

[Clinical, microbiological, and therapeutic aspects of Nocardia sp. infections in the Bordeaux hospital from 1993 to 2003].

OBJECTIVE: Our goal was to describe the epidemiological, clinical, and microbiological characteristics of nocardiosis in the Bordeaux teaching hospital, between January 1, 1993 and December 31, 2003. DESIGNS: The retrospective study included patients examined between January 1, 1993 and December 31, 2003 in whom a Nocardia bacterium had been identified from a biological sample. RESULTS: Twenty-four out of 30 Nocardia sp. strains identified during the study period were classified as colonizing strains. 19 patients presented with risk factors for nocardiosis. Nocardia asteroïdes were found in 22 samples, mainly from pulmonary samples. 11 cases of infection due to Nocardia sp. were reported during the study period. Immunosuppression was reported in 7 cases. The clinical forms were not specific. The species incriminated belonged to the N. asteroïdes complex in 8 cases. Treatment consisted in a combination of 2 or 3 molecules including cotrimoxazole for an average duration of 9 months. 9 patients recovered. CONCLUSIONS: The variability of clinical presentation and the lack of standard identification methods delayed the diagnostic. The treatment is not well defined. Clinical strains should be reported to the reference laboratory and prospective studies are necessary.

Anti-Bacterial Agents↗
PubMed2004

Comparison of PCR and culture for detection of Nocardia asteroides in brain specimens from experimentally infected BALB/c mice.

Systemic infection of BALB/c mice with Nocardia asteroides strain GUH-2 results in widespread replication of the organism in the brain, followed by its immune-mediated clearance. The present study compared the sensitivity of polymerase chain reaction (PCR) to bacterial culture for detection of cerebral nocardial infection in this experimental system. Mice (n=4/time point) were administered N. asteroides by intravenous injection, and brain specimens were evaluated for Nocardia by PCR and culture at post-infection days 2, 7, 14 and 21. Nocardia was detected by PCR in all infected animals on post-infection days 2, 7, and 14, and in one of four mice on post-infection day 21; in contrast, the organism was detected by culture only on post-infection days 2 and 7. These findings suggest that PCR may be more sensitive than culture for the detection of low numbers of Nocardia in the brain.

Animals↗
PubMed1990

Nocardia asteroides pericarditis: report of a case and review of the literature.

In this report, we describe a patient who had purulent Nocardia asteroides pericarditis. In addition, we identified 13 previously suspected and reported cases of Nocardia pericarditis, but only 5 of these studies reported isolation of Nocardia from cultures of pericardial fluid or pericardium. Analysis of the clinical course of these five patients and our patient revealed the importance of long-term sulfonamide antibiotic therapy in combination with surgical pericardial drainage procedures. In our review, only patients who received antibiotics and underwent pericardiectomy survived. Our case substantiates the excellent penetration of sulfisoxazole into the pericardial fluid, even with oral administration of the drug, and provides evidence in support of aggressive management of Nocardia pericarditis.

Adult↗
PubMed2000

Genetic relatedness analysis of nocardia strains by random amplification polymorphic Dna: validation and applications.

Until now, no simple and rapid technique existed for epidemiological study of strains belonging to the Nocardia genus. The application of the arbitrarily primed PCR procedure to generate randomly amplified polymorphic DNA (RAPD) fingerprints for such analysis of Nocardia isolates was investigated. Fifty-one unrelated clinical isolates of N. asteroides were tested. Two conditions of RAPD using two different primers generated RAPD fingerprints that allowed the differentiation of all strains. The patterns were reproducible and discriminating. The results highlight the diversity of N. asteroides species and confirm that RAPD analysis is a highly valuable tool for studying the epidemiology of the Nocardia genus. Several examples describe the advantage of RAPD analysis for establishing the relationship between isolates from a given patient (long-term infections, coinfections) and from different patients (i.e. during an outbreak). In the future, this technique will help us to investigate the source of infection in cases of nosocomial transmission, to understand the outcome of nocardiosis, and to follow the evolution and acquisition of resistance to Nocardia strains.

Bacterial Typing Techniques↗
PubMed2000

Nocardia infection in heart-lung transplant recipients at Alfred Hospital, Melbourne, Australia, 1989-1998.

Nocardia infections are uncommon in recipients of heart, lung, or heart-lung transplants, but such infections are well described. Frequent episodes of rejection, high-dose prednisolone treatment, renal impairment, and prolonged respiratory support have all been shown to increase the risk of Nocardia infection in this group. In this retrospective review of 540 recipients of heart, lung, or heart-lung transplants, 10 patients developed Nocardia infection (frequency, 1.85%). Infection occurred at a mean +/- standard deviation of 13+/-14.5 months after transplantation. All patients had pulmonary disease with no evidence of extrapulmonary disease. The Nocardia infection did not contribute directly to patient deaths. Coinfection with other pathogens was present in 6 patients, and 2 patients had sequential infections. Radiological findings varied. All isolates were susceptible to trimethoprim-sulfamethoxazole, amikacin, and imipenem. Treatment regimens varied. Two (30%) of 6 patients treated with trimethoprim-sulfamethoxazole developed adverse reactions, which necessitated a change in antibiotic therapy. The optimal treatment regimen, which comprises both the antimicrobial agent and the length of treatment, is unclear.

Adult↗
PubMed2000

Nocardia asteroides pericarditis in association with HIV.

This case report describes Nocardia pericarditis in a newly diagnosed human immunodeficiency virus (HIV) patient as an initial manifestation. Previously, two cases of Nocardia pericarditis were reported in patients with established HIV infection. To our knowledge this is the first case of Nocardia pericarditis as an initial manifestation of HIV infection. This case substantiates and emphasizes the importance of identifying Nocardia as an infectious cause of pericarditis in patients with acquired immunodeficiency. Long-term survival may be achieved with a combined medical and surgical approach.

AIDS-Related Opportunistic Infections↗
PubMed1995

Primary cutaneous Nocardia otitidiscaviarum infection: case report and review.

Organisms of the genus Nocardia cause a variety of illnesses in humans and other mammals. Nocardiae normally enter the body via the respiratory tract, but they may also be directly inoculated into the skin, causing primary cutaneous disease. Nocardia otitidiscaviarum is one of the less commonly isolated species of Nocardia, but it can produce localized or disseminated infection. We report a case of primary cutaneous N. otitidiscaviarum infection and review the clinical and microbiological features of other reported cases. Cutaneous N. otitidiscaviarum infection usually occurs in the setting of trauma, most often in otherwise healthy hosts. The manifestations of N. otitidiscaviarum skin infection range from cellulitis and abscess formation to the development of mycetomas. Cutaneous infection by N. otitidiscaviarum can mimic disease caused by more common pyogenic organisms, often leading to delay in diagnosis and treatment. Appropriate antibiotic therapy, usually with a sulfa drug-containing regimen, is generally successful.

Aged↗
PubMed1983

Effect of virulent and less virulent strains of Nocardia asteroides on acid-phosphatase activity in alveolar and peritoneal macrophages maintained in vitro.

Since virulent strains of Nocardia asteroides grow within macrophages, experiments were designed to determine whether this intracellular pathogen affects lysosomal enzyme levels. Peritoneal and alveolar macrophages from mice were infected in vitro with live or killed N asteroides of the virulent strain GUH-2 or with live nocardiae of the less virulent strain 10905, which is killed by macrophages. The activity of acid phosphatase in individual macrophages was quantitated by means of a computer-assisted cytospectrophotometry system. Slide preparations were Gram stained for quantitation of ingested nocardiae in the same macrophages. The level of acid phosphatase activity in alveolar and peritoneal macrophages was decreased by infection with live cells of the virulent strain; the level of activity was inversely proportional to the number of nocardiae ingested. This effect was not seen with killed bacteria of this strain or with live bacteria of the less virulent strain. These results demonstrate a relation between the virulence of N asteroides strains and the extent of reductions in lysosomal acid-phosphatase activity of macrophages.

Acid Phosphatase↗
PubMed1987

Contribution of neutrophils and cell-mediated immunity to control of Nocardia asteroides in murine lungs.

To distinguish between the contributions of neutrophils and cell-mediated immunity to defense against Nocardia asteroides in the lung, we induced pneumonia in BALB/c mice by intranasal inoculation. We studied the course of pneumonia by histology, bronchoalveolar lavage, and quantification of colony-forming units in lungs. Mice with intact host defenses had an initial inflammatory response, consisting mostly of neutrophils, followed by a mononuclear cell infiltrate. Nocardiae were eradicated during the seven days after inoculation. Mice in which the early, predominantly neutrophil inflammatory response was prevented with mechlorethamine or antiserum to neutrophils had little inflammation, and nocardiae grew extensively. Mice in which cell-mediated immunity was impaired with cyclosporin A or cortisone acetate developed abscesses; neutrophils were abundant, but nocardiae proliferated. The occurrence of these three separate and distinct patterns suggested that both neutrophils and cell-mediated immunity are necessary for optimal control of N. asteroides infection.

Animals↗
PubMedDate not supplied

Synergistic action of trimethoprim and sulfamethoxazole for Nocardia asteroides: efficacious therapy in five patients.

Eighteen isolates of Nocardia asteroides were tested for in vitro susceptibility to trimethoprim (TMP) and sulfamethoxazole (SMZ) alone and in various combinations using disc and paper strip diffusion tests. TMP-SMZ showed synergistic action for two-thirds of teh nocardia isolates tested. Five patients with Nocardia pneumonia were treated with TMP-SMZ and all were cured. Four of the patients' isolates were tested and all showed synergistic patterns of inhibition with the spaced disc and paper strip methods. The agar diffusion disc and synergy tests of TMP-SMZ appear to correlate with clinical usefulness when the Nocardia are susceptible with large zones of inhibition around the combination TMP-SMZ disc.

Adult↗
PubMed1998

Nocardia crassostreae sp. nov., the causal agent of nocardiosis in Pacific oysters.

Seven strains of bacteria were isolated from Pacific oysters, Crassostrea gigas, with a focal or systemic disease. The strains were aerobic, Gram-positive, acid-fast, produced a mycelium which fragmented into irregular rod-like elements, had a peptidoglycan containing meso-diaminopimelic acid, arabinose and galactose as major sugars, mycolic acids with 46-58 carbon atoms and G + C-rich DNA. All of these properties are consistent with the classification of the organisms in the genus Nocardia. A partial sequence of the 16S rRNA gene of isolate NB4H was determined following isolation and cloning of the PCR-amplified gene. The sequence was aligned with those of representative mycolic-acid-containing taxa and a phylogenetic tree was generated using the neighbour-joining method. It was evident from the phylogenetic tree that the three strains tested, RB1, OB3P and NB4H, were identical and belonged to the Nocardia otitidiscaviarum rRNA sub-group. The biochemical, chemical, morphological and physiological properties of the isolates were also essentially identical and served to distinguish them from representative nocardiae. It is, therefore, proposed that the strains isolated from the diseased Pacific oysters be assigned to a new species, Nocardia crassostreae. The type strain is NB4H (= ATCC 700418).

Animals↗
PubMed2006

Nocardia exalbida sp. nov., isolated from Japanese patients with nocardiosis.

Two bacterial strains isolated from different hospitals in Japan were subjected to a polyphasic analysis. Strains IFM 0803(T) and IFM 10383 were found to have morphological, biochemical, physiological and chemotaxonomic properties consistent with their classification in the genus Nocardia. Strains IFM 0803(T) and IFM 10383 clustered with the type strain of Nocardia xishanensis, showing 16S rRNA gene sequence similarities of 98.6-98.9 % with this species. The novel strains could be distinguished from N. xishanensis by a range of phenotypic properties. Based on their phenotypic and phylogenetic characteristics, the two isolates are proposed as members of a novel species of the genus Nocardia, Nocardia exalbida sp. nov., with the type strain IFM 0803(T) (=NBRC 100660(T) = JCM 12667(T) = DSM 44883(T)).

Humans↗
PubMed2004

Trimethoprim-sulphamethoxazole therapy in Nocardia keratitis.

PURPOSE: To describe the clinical features, microbiological features and treatment outcome of nine patients with Nocardia keratitis treated with topical trimethoprim- sulphamethoxazole drops. METHODS: Retrospective review of nine patients with culture-proven Nocardia keratitis. RESULTS: Nine patients with Nocardia keratitis were treated with topical trimethoprim-sulphamethoxazole drops. The average duration of treatment was 25 +/- 9 days. Five of the nine patients presented with superficial ulcers with margins studded with yellowish white discrete pinhead sized infiltration; the other four patients had deep stromal infiltration. Complete healing of the ulcer was achieved in six out of the nine patients with topical trimethoprim- sulphamethoxazole alone or in combination with ciprofloxacin 0.3% eye drops. CONCLUSION: Topical application of trimethoprim-sulphamethoxazole appears to be effective therapy for superficial keratitis due to Nocardia.

Adolescent↗
PubMed1993

Interactions of Nocardia asteroides with murine glia cells in culture.

Astrocytes and microglia were obtained from brains of newborn mice and infected with Nocardia asteroides. Scanning electron micrographs showed nocardiae adhering to the astrocyte cell surface and entering the cytoplasm. After 6 h of incubation the intracellular nocardiae appeared as filaments, demonstrating that growth was occurring. In contrast, the microglia phagocytized nocardiae, but after 6 h the presence of coccoid cells indicated that nocardial growth was inhibited.

Animals↗
PubMed1963

ANTIGENIC STRUCTURE OF ACTINOMYCETALES. VI. SEROLOGICAL RELATIONSHIPS BETWEEN ANTIGENIC FRACTIONS OF ACTINOMYCES AND NOCARDIA.

Kwapinski, J. B. (University of New England, Armidale, N.S.W., Australia). Antigenic structure of Actinomycetales. VI. Serological relationships between antigenic fractions of Actinomyces and Nocardia. J. Bacteriol. 86:179-186. 1963.-A total of 52 chemical fractions were obtained by a comprehensive technique of preparation from three strains of Actinomyces and three strains of Nocardia. The chemical and serological structures and specificities of disintegrated cells, cell walls, cytoplasms, and individual fractions were thoroughly studied. Cytoplasmic materials were found to be serologically alike or identical. The polysaccharide fractions, extracted from cell walls with alkali, formamide, and phenol, proved to be serologically related. Fractions prepared from the Nocardia by extractions in hot and concentrated solutions of acetic acid and sodium hydroxide, as well as the second protein fraction and the acetate-extracted polysaccharides of both the Nocardia and Actinomyces, proved to be genus-specific.

Actinomyces↗
PubMed1996

Novel method for rapid identification of Nocardia species by detection of preformed enzymes.

The purpose of the present study was to devise a method for the identification of Nocardia species that is more technically simple, accurate, and rapid than current standard methods of identification. We focused on a commercial bacteria identification system that contained chromogenic test substrates. Two MicroScan products were selected for use in the study on the basis of their content of chromogenic and conventional substrates. They were the Rapid Anaerobe Identification and the HNID panels. A total of 85 strains of Nocardia representing five species were used in the study. All isolates were identified as Nocardia species by the use of standard methods. The beta-naphthylamide-labeled substrate L-pyrrolidonyl-beta-naphthylamide (PYR), the nitrophenyl-labeled substrate p-nitrophenyl-alpha-D-mannopyranoside (MNP), and indoxyl phosphate were found to be useful for identification purposes. N. farcinica and N. nova were the only species positive for PYR, whereas N. brasiliensis was the only species that hydrolyzed MNP. All strains of N. brasiliensis, N. otitidiscavarium, and N. farcinica were positive for indoxyl phosphate, whereas strains of N. nova and N. asteroides sensu stricto were always negative. Agreement between the standard and enzymatic identification methods was 100%. In summary, detection of preformed enzymes appears to be a simple and reproducible method for the identification of Nocardia spp.

Bacteriological Techniques↗
PubMed2003

Nocardia veterana as a pathogen in North American patients.

The molecular methodologies used in our laboratories have allowed us to define a group of Nocardia isolates from clinical samples which resemble the type strain of Nocardia veterana. Three patient isolates and the type strain of N. veterana gave identical and distinctive restriction fragment length polymorphisms (RFLPs) for an amplified portion of the 16S rRNA gene. These three isolates and the N. veterana type strain also gave identical RFLPs for an amplified portion of the 65-kDa heat shock protein gene, but this pattern was identical to that obtained for the Nocardia nova type strain. Sequence analysis of both a 1,359-bp region of the 16S rRNA gene and a 441-bp region of the heat shock protein gene of the patient isolates showed 100% identities with the same regions of the N. veterana type strain. DNA-DNA hybridization of the DNA of one of the patient isolates with the DNA of the N. veterana type strain showed a relative binding ratio of 82%, with 0% divergence, confirming that the isolate was N. veterana. Biochemical and susceptibility testing showed no significant differences among the patient isolates and the N. veterana type strain. Significantly, the results of antimicrobial susceptibility testing obtained for our isolates were similar to those obtained for N. nova, indicating that susceptibility testing alone cannot discriminate between these species. We present two case studies which show that N. veterana is a causative agent of pulmonary disease in immunocompromised patients residing in North America. We also describe difficulties encountered in using 16S rRNA gene sequences alone for discrimination of N. veterana from the related species Nocardia africana and N. nova because of the very high degree of 16S rRNA gene similarity among them.

Adult↗