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[Pulmonary nocardiosis as a cause of radiographic imaging of multiple pulmonary nodules].

Lung nocardiosis is a rare disease affecting patients with lymphoreticular neoplasm, immunodeficiency or chronic obstructive pulmonary disease; it can also affect patients who have received transplants. We report a case of lung nocardiosis in which radiographic presentation was acute, with a pattern of multiple bilateral pulmonary nodules ("cannonballs"), requiring us to rule out metastatic disease to arrive at a diagnosis. The patient responded slowly to antibiotic treatment until full resolution.

Aged↗

A case of Nocardia epidural abscess.

Spinal epidural abscess due to nocardia is extremely rare. We report a patient who presented to our Emergency Department with a complaint of low back pain and fever, who was later found to have a spinal epidural abscess. Tissue cultures from the abscess grew nocardia asteroides. Magnetic resonance imaging scan is the imaging study of choice for diagnosing spinal epidural abscess. Treatment for nocardia spinal epidural abscess involves a combination of surgical debridement and prolonged sulfonamide administration.

Abscess↗

Nocardial brain abscess in a renal transplant recipient.

Nocardial brain abscess is rare and accounts for about 1-2% of all cerebral abscesses. However, the early detection and treatment of it is very important because the mortality of it is three times higher than that of other bacterial brain abscesses. We report a case of nocardial brain abscess in a renal transplant recipient. Enhanced brain CT and MR scans showed multiple conglomerated ring-enhancing lesions with budding appearance and distinct surrounding edema.

Brain↗

Nocardia asteroides abscess after heart transplantation.

We describe a patient who developed a primary, thigh adductor-muscle abscess caused by Nocardia asteroides 3 years after orthotopic cardiac transplantation. Nocardia was diagnosed by microbiologic culture and responded fully to a prolonged course of cotrimoxazole. The patient remains free of local or systemic disease at 2 years follow-up.

Abscess↗

Nocardia asteroides in the soil of Kuwait.

A pilot study was undertaken to determine the occurrence and distribution of pathogenic nocardiae in Kuwaiti soil. A total of 102 soil samples collected from two localities were investigated by the paraffin bait technique. Nocardia asteroides was the only species isolated from 42 (41%) soil samples. None of the isolates fulfilled the criteria required for identification of N. farcinica or N. nova. Thirty one (73.8%) isolates showed equivalent growth at 45 degrees C and 35 degrees C, 17 (40.4%) isolates utilized acetamide for carbon and nitrogen requirements and 3 (7.1%) isolates showed delayed arylsulphatase activity. Only a solitary isolate was resistant to cefamandole. Soil samples originating from the Kuwait University Campus, Shuwaikh, which were rich in humus/organic matter, were more productive for N. asteroides (67%) than the samples which were devoid of it but were mixed with crude oil (39%). Sand samples that lacked organic matter and crude oil samples were least productive of N. asteroides. These preliminary findings do not suggest that massive oil contamination of soil in the Ahmadi oil field area during the Gulf war promoted the natural occurrence of N. asteroides. However, isolation of N. asteroides in as many as 41% of the soil sample is a significant observation warranting further epidemiologic studies including its possible role in the operation desert storm sickness syndrome. This is the first report on the natural occurrence of N. asteroides in Kuwait.

Fuel Oils↗

A study of the enzymatic profile of soil isolates of Nocardia asteroides.

In this study, using the API-ZYM system, we have reported the enzyme profile of 42 soil strains and 2 clinical strains of Nocardia asteroides isolated locally. Of the 19 enzymes tested, only 7 were demonstrable in over 90% of the soil isolates. These included alkaline phosphatase, esterase lipase, leucine arylamidase, acid phosphatase, phosphohydrolase, alpha-glucosidase and beta-glucosidase. In addition, beta-galactosidase activity was demonstrated in all the strains by the O-nitrophenyl-beta-D-galactopyranoside (ONPG) test. The enzymes which were not demonstrable in > 95% of the strains included valine arylamidase, cystine arylamidase, trypsin, chymotrypsin, alpha-galactosidase, beta-glucoronidase, N-acetyl-beta-glucosaminidase, alpha-mannosidase and alpha-fucosidase. With the exception of valine arylamidase, which was lacking in all but one isolate, the enzyme profiles of the soil isolates were comparable with the clinical isolates of N. asteroides reported in previous studies. The reasons for this difference in the two sets of isolates is not clear. The study reinforces the view that specific differences in the enzymatic profiles of Nocardia species could be used for their rapid identification. However, more extensive studies are needed to establish the reproducibility of this method. To the best of our knowledge, this is the first study of the enzymatic profile of soil isolates of N. asteroides originating from a single geographic region.

Esterases↗

Pemphigus vulgaris and disseminated nocardiosis.

Infectious diseases, in particular septicaemia from Staphylococcus aureus, Proteus vulgaris and Pseudomonas aeruginosa, are the most severe and frequent complications for the immunosuppressive therapy of pemphigus. Infection by Nocardia asteroides in subjects with pemphigus vulgaris is rare. We report the sixth case found of such an association; the subject died of disseminated nocardiosis while receiving steroids and immunosuppressive drugs, 4 years after being diagnosed with chronic pemphigus vulgaris.

Anti-Inflammatory Agents↗