'Nocardia asteroides' mycetoma of the foot.
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The study describes an easy and reproducible technique of producing pulmonary nocardiosis in monkeys, yielding consistent morbidity and mortality results. Introduction of the fungal suspension into the lower canaliculus, with or without debridement of the canalicular epithelium, produced fatal pneumonitis in 1-2 weeks. Specificity of the lesions was determined by demonstration of Nocardia in tissue sections and in culture.
Benzylpenicillin, amoxicillin, amoxicillin plus clavulanic acid, cephalothin, cephaloridine, cefotaxime, imipenem, erythromycin, clarithromycin, azithromycin, amikacin, ciprofloxacin and trimethoprim-sulfamethoxazole were tested in vitro by the agar dilution method against eleven strains of Nocardia asteroides isolated both from AIDS and other immunocompromised patients. Imipenem, amikacin and trimethoprim-sulfamethoxazole were shown to be the most active drugs with minimum inhibitory concentrations (MIC) values nearly always lower than concentrations achievable in blood. Ciprofloxacin, cephaloridine and cefotaxime were moderately active, while the remaining drugs were totally ineffective. When susceptibility was assessed by the radiometric method the MIC90 values were uniformly lower than those in the agar method, possibly due to lower inactivation of drugs during incubation. The two methods showed a good correlation only for imipenem, amikacin and ciprofloxacin. The results obtained by the radiometric method seem to indicate that, as for mycobacteria, this method may also give a more accurate evaluation of the antimicrobial susceptibility of Nocardiae.
Nocardia bacteremia is very rare. We report 2 cases of central venous catheter-associated Nocardia bacteremia and review the literature. The limited clinical experience suggests that discontinuing the catheter and embarking on a relatively short course of appropriate antibiotics results in a good outcome.
A 39-year-old man with a history of injection drug abuse was given a diagnosis of Nocardia asteroides native aortic valve endocarditis, and he required valve replacement therapy, despite having received potent antimicrobial therapy. This is the first reported proven case of native valve endocarditis due to Nocardia species.
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A simple timesaving method for determining drug susceptibilities in vitro of isolates of Nocardia and Actinomadura is reported. An isolate is considered "susceptible" when the quantity of drug required for inhibition of growth is that concentration which might be obtained in serum by conventional therapy. Sulfonamides remain the drugs of choice for treating disease due to Nocardia species. Although doxycycline and minocycline appear to be very effective against Nocardia species, susceptibility testing may be desirable when a physician is considering substitution of an antibiotic for a sulfonamide. Susceptibility testing also may be desired before a drug is selected for treating disease due to Actinomadura madurae.
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Diagnosis of nocardiosis is often delayed because of the frequently nonspecific nature of the illness and because of the long incubation period required to isolate the organism in the microbiology laboratory. Past experience with serological methods for diagnosing nocardiosis have met with little success, primarily because there was no suitable antigen. Using a previously identified Nocardia asteroides-specific protein, we developed an enzyme immunoassay for the rapid diagnosis of nocardiosis. We evaluated sera from 22 patients with nocardiosis, 83 hospitalized controls, and 21 patients with tuberculosis. Twenty (91%) of the sera from patients with nocardiosis had titers of antibody greater than or equal to 1:256, whereas all of the sera from controls and from patients with tuberculosis had titers less than 1:256. This assay represents a highly sensitive and specific serodiagnostic tool for evaluating patients with possible nocardiosis.