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Nocardioses are unusual broncho-pneumopathies with a dangerous evolution which should be better known. They occur usually, except in case no. 1, in patients with decreased immunity. For this reason they belong to superinfection with opportunist germs. It should be kept in mind when identfying the nocardia so as to start an early specific treatment.
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The distribution of Nocardia asteroides (Eppinger) Blanchard, the main causative agent of nocardiosis in humans and animals, in the soils of the Ukrainian SSR was studied. This species was found to inhabit cultivated soils in various soil-climatic zones of the Ukrainian SSR. The isolated strains proved to be heterogeneous in their properties. N. asteroides fell into 2 groups: acetamidase-negative (A) and acetamidase-positive (B). Newly isolated N. asteroides belonging to the acetamidase-positive group were shown to be always pathogenic, whereas the organisms of the acetamidase-negative group could be pathogenic and non-pathogenic in white mice.
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A patient with severe pulmonary nocardiosis occurring in the early posttransplant period is presented. Three outstanding features characterized this case: 1) the failure to diagnose this rare opportunitistic pathogen by conventional detection methods necessitated open lung biopsy; 2) the initiation of trimethoprim-sulphamethoxazole therapy resulted in a dramatic clinical response; and 3) an allograft recipient with a low immunological response contracted nocardiosis. His immune status became apparent following pretransplant donor-specific blood transfusion tests, unresponsiveness to third-party transfusion and graft tolerance permitting the permanent withdrawal of azathioprine without graft function impairment.
Osteitis of the forearm due to Nocardia asteroides was noted in an 8 year old tunisian boy 14 months after an open fracture. This observation of direct inoculation of bone by Nocardia asteroides was atypical because of the remarkable nature of the hyperostotic reaction.
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