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[Acute community acquired pneumopathy caused by Nocardia asteroides in a 93-year-old female patient].

BACKGROUND: Lower respiratory tract infection (LRTI) by Nocardia species is most often considered as an opportunistic infection occurring mainly in middle-aged adults. CASE REPORT: A 93-year old woman without any significant comorbidity other than a mild asthma, presenting with a non-resolving pneumonia, was successfully treated for a community-acquired LRTI by Nocardia asteroides. DISCUSSION: LRTI by Nocardia asteroides is a rare occurrence. Although more frequent in immuno-compromised patients (50 to 85% of cases reported), Nocardia asteroides infection also occurs in immuno-competent individuals. Very few reports describe LRTI infection by Nocardia sp. in the very old, and almost exclusively in patients with major co-morbidities or variable degrees of immuno-suppression.

Acute Disease↗

[Isolation of three species of Nocardia in a patient receiving long-term corticosteroid therapy].

INTRODUCTION: Nocardia are saprophyte bacteria of the environment responsible for systemic infections in immunodepressed patients, due essentially to long-term corticosteroids. OBSERVATION: A patient having received corticosteroids for sarcoidoses for a year was hospitalised because of disseminated granulomatosis (neurological, respiratory, abdominal and cutaneous). Culture of various bacteriological samples isolated three species of Nocardia: N. otitidiscaviarum in uretheral pus and pus from the right gland, N. nova and N. asteroides in respiratory samples (protected distal sampling and broncho-alveolar washing). COMMENTS: Other than the mixed Nocardia infections described habitually, infections with two different species of Nocardia have recently been reported. Our case report is the first to have isolated three concomitant species of Nocardia.

Adrenal Cortex Hormones↗

Application of sucrose-gradient centrifugation for selective isolation of Nocardia spp. from soil.

AIMS: To devise and evaluate a method for selective isolation of the less abundant actinomycetes, Nocardia spp. in soil. METHODS AND RESULTS: This newly developed method is based on differentiating Nocardia from other actinomycete taxa by centrifugation. A water suspension of air-dried soil is centrifuged through a gradient consisting of 10, 20, 30, 40 and 50% sucrose at 240 x g for 30 min. The 20% sucrose layer, which is enriched with Nocardia spp., is then diluted and plated on humic acid-vitamin agar supplemented with antibacterial agents. The proposed method consistently achieved selective isolation of Nocardia spp. in all 14 soil samples tested, which accounted for 5-89% of the total microbial population recovered. Tentative taxonomic characterization based on a restriction fragment length polymorphism (RFLP) analysis of the 16S ribosomal DNA suggested that many of the soil isolates could belong to N. asteroides, N. salmonicida or N. uniformis. CONCLUSIONS: Differential centrifugation can successfully and efficiently isolate soil Nocardia populations that are suppressed by conventional dilution plating approaches. SIGNIFICANCE AND IMPACT OF THE STUDY: The development and application of new methodologies with which to isolate less-explored actinomycete taxa is important for improving our knowledge about their taxonomy, ecology and industrial applications.

Anti-Bacterial Agents↗

Reduction of carboxylic acids by Nocardia aldehyde oxidoreductase requires a phosphopantetheinylated enzyme.

Aldehyde oxidoreductase (carboxylic acid reductase (Car)) catalyzes the magnesium-, ATP-, and NADPH-dependent reduction of carboxylic acids to their corresponding aldehydes. Heterologous expression of the car gene in Escherichia coli afforded purified recombinant enzyme with a specific activity nearly 50-fold lower than that of purified native Nocardia sp. enzyme. The 5-fold increase in specific activity obtained by incubating purified recombinant Car with CoA and Nocardia cell-free extracts indicated that post-translational phosphopantetheinylation of Car is required for maximum enzyme activity. Nocardia phosphopantetheine transferase (PPTase) expressed in E. coli was isolated and characterized. When incubated with [(3)H]acetyl-CoA and Nocardia PPTase, the labeled acetylphosphopantetheine moiety was incorporated into recombinant Car. Coexpression of Nocardia Car and PPTase in E. coli gave a reductase with nearly 20-fold higher specific activity. Site-directed mutagenesis in which Ser(689) was replaced with Ala resulted in an inactive Car mutant. The results show that Car expressed in Escherichia coli is an apoenzyme that is converted to a holoenzyme by post-translational modification via phosphopantetheinylation. Doubly recombinant resting E. coli cells efficiently reduce vanillic acid to vanillin.

Aldehyde Oxidoreductases↗

The foaming inhibitor on Nocardia and alike (FIONA) process.

A new process to abate foam-causing micro-organisms of the genus of Nocardia sp. and alike was developed in the Sha Tin Sewage Treatment Works of Hong Kong in 2002 under an in-house research and development study. The new FIONA process relates to a process of inhibiting the growth of the foam-causing micro-organisms of genus Nocardia sp. and alike, which are commonly found in activated sludge sewage treatment process with nutrient removal. The Sha Tin Sewage Treatment Works is the largest secondary sewage treatment works in Hong Kong with nitrogen removal capability. It has been suffering from Nocardia foam since its commissioning in 1982, which had led to consistent non-compliant events. The new process has been put into full scale application since 2002 and its foaming abatement effect is very effective; resulting in resumption of full compliance with the discharge licence since November 2003. The FIONA Process basically comprises a chemical dosing system and a reaction zone with a mean hydraulic retention time of 1 hour. The dosing point of the Process can be at upstream sewage pumping stations as well as the inlet works of the sewage treatment works. The dosing chemicals are to create an anoxic environment in the sewage so as to boost up the removal of the readily biodegradable substrates, which are favourable substrates of the foam-causing micro-organisms, in the sewage prior to entering the bioreactors. In such way, it will help out-compete the foam-causing micro-organisms in the bioreactors. Full scale dosing results in the Sha Tin Sewage Treatment Works from 2002 to 2004 had demonstrated that the previous year-round appearance of the Nocardia foam in the bioreactors had been greatly abated to an extent from little to moderate appearance only from January to April with complete Nocardia foam disappearance from May to December. The dosing chemical being used is calcium nitrate at dosing rates from 15 to 50 mL of aqueous calcium nitrate at 50% concentration by weight (equivalently 50 to 150 mM of calcium nitrate) per m3 of sewage. For other metallic nitrate salts, the nitrate mass content must be equivalent to the nitrate mass of calcium nitrate at the above dosing range. For hydrogen peroxide, it is believed the same effect would occur, however, there is no practical data available. A theory for the FIONA Process based on the bio-selector effect is also proposed albeit further research is necessary for its substantiation.

Bioreactors↗

Lack of synergy between phagocytes and antimicrobials against Nocardia asteroides.

Previous observations suggested that synergy between antimicrobials and phagocytes may occur during Nocardia asteroides infection. We incubated N. asteroides with seven antimicrobials, and then exposed the nocardiae to phagocytes. Neutrophils and monocytes killed about half the nocardiae whether or not the nocardiae had been preincubated with antimicrobials. We also determined whether exposure to neutrophils led to increased susceptibility of nocardiae to antimicrobials, and it did not. We found no evidence for synergy between antimicrobials and phagocytes in host defence against this bacterium.

Adult↗

In-vitro activity of new carbapenem antibiotics: comparative studies with meropenem, L-627 and imipenem against pathogenic Nocardia spp.

MICs of two new carbapenems, meropenem and L-627, and imipenem were determined against 98 strains of the Nocardia asteroides group (i.e. N. asteroides sensu stricto, Nocardia farcinica and Nocardia nova), 46 strains of Nocardia brasiliensis and 17 strains of Nocardia otitidiscaviarum. Meropenem and L-627 were less active against the N. asteroides group than imipenem. Among the three species of the N. asteroides group, N. nova was the most sensitive to all the carbapenems. Meropenem was more active than imipenem against both N. brasiliensis and N. otitidiscaviarum with MIC50 values of 28.3-53.3 mg/L. L-627 was less active than meropenem.

Carbapenems↗

A case of disseminated infection with Nocardia brasiliensis in a lung transplant recipient.

BACKGROUND: Infection with Nocardia species is an increasingly recognized complication of solid organ transplantation. Nocardia asteroides accounts for most transplant-related nocardiosis, while Nocardia brasiliensis rarely causes infection in organ transplant recipients. METHODS: We describe a case of disseminated infection with N brasiliensis in a single-lung transplant recipient who also had concomitant infections with viral and fungal organisms. RESULTS: Although the mortality rate is high in immunocompromised patients with disseminated Nocardia infection, our patient responded favorably to prolonged antimicrobial therapy. CONCLUSIONS: This case illustrates that N brasiliensis, like N asteroides, produces pulmonary disease and dissemination in solid organ transplant recipients, and demonstrates the utility of prolonged treatment with trimethoprim-sulfamethoxazole in Nocardia infections.

Biopsy↗

Nocardia neocaledoniensis sp. nov., a novel actinomycete isolated from a New-Caledonian brown hypermagnesian ultramafic soil.

The taxonomic position of an actinomycete isolated from a hypermagnesian ultramafic soil was examined using a polyphasic approach. The strain, designated SBH(R) OA6(T), was shown to have chemical and morphological properties typical of members of the genus Nocardia. The organism was most closely associated with Nocardia asteroides using 16S rRNA gene sequence data. It showed a distinctive set of phenotypic properties that distinguished it from representatives of all species with validly published names classified in the genus Nocardia. The combined genotypic and phenotypic data show that strain SBH(R) OA6(T) (=DSM 44717(T)=NCIMB 13955(T)) merits description as the type strain of a novel Nocardia species, Nocardia neocaledoniensis sp. nov.

DNA, Bacterial↗

In vitro response of rabbit alveolar macrophages to infection with Nocardia asteroides.

The interaction of Nocardia asteroides with cultured "normal" nonimmune rabbit alveolar macrophages was studied by light and electron microscopy. It was shown that the alveolar macrophage response to the more virulent strain (N. asteroides 14759) was quite different from the response to the less virulent organism (N. asteroides 10905). N. asteroides 14759 elicited a dramatic in vitro response of the macrophages toward the nocardial infection. Within a few hours postinfection, there was a migration of macrophages toward other cells actively infected with viable nocardia, so that at 6 h considerable macrophage aggregation on the cover slips had occurred. Many of the macrophages within these aggregates exhibited tight cell-to-cell contact, whereas others were observed to fuse, forming multinucleate giant cells, with many containing more than 10 nuclei. Upon continued incubation, these giant cells appeared to destroy the intracellular nocardia, so that, at 24 h postinfection, gram-positive, ultrastructurally intact bacteria could not be observed. At the same time, some of the macrophage aggregates that did not fuse appeared to be unable to stop the intracellular growth of nocardia. At 12 to 24 h large numbers of gram-positive, acid-fast filaments were observed growing out from within these macrophage aggregates. The macrophage response seemed dependent upon the strain of Nocardia infecting them, since N. asteroides 10905 did not induce a similar response within the macrophage population.

Animals↗

Analysis of secA1 gene sequences for identification of Nocardia species.

Molecular methodologies, especially 16S rRNA gene sequence analysis, have allowed the recognition of many new species of Nocardia and to date have been the most precise methods for identifying isolates reliably to the species level. We describe here a novel method for identifying Nocardia isolates by using sequence analysis of a portion of the secA1 gene. A region of the secA1 gene of 30 type or reference strains of Nocardia species was amplified using secA1-specific primers. Sequence analysis of 468 bp allowed clear differentiation of all species, with a range of interspecies similarity of 85.0% to 98.7%. Corresponding 16S rRNA gene sequences of a 1,285-bp region for the same isolates showed a range of interspecies similarity of 94.4 to 99.8%. In addition to the type and reference strains, a 468-bp fragment of the secA1 gene was sequenced from 40 clinical isolates of 12 Nocardia species previously identified by 16S rRNA gene sequence analysis. The secA1 gene sequences of most isolates showed >99.0% similarity to the secA1 sequences of the type or reference strain to which their identification corresponded, with a range of 95.3 to 100%. Comparison of the deduced 156 amino acid sequences of the SecA1 proteins of the clinical isolates showed between zero and two amino acid residue differences compared to that of the corresponding type or reference strain. Sequencing of the secA1 gene, and using deduced amino acid sequences of the SecA1 protein, may provide a more discriminative and precise method for the identification of Nocardia isolates than 16S rRNA gene sequencing.

Adenosine Triphosphatases↗

[Study on the reclassification of two deposited strains AS4.1186 and AS4.1187 of Nocardia].

Polyphasic evidence for the reclassification of Nocardia nostocoides AS4.1186 and Nocardia salmonicolor var. aurantiaca AS4.1187 indicated that strain AS4.1186 was closely related to Saccharothrix texasensis and strain AS4.1187 was very closely related to Rhodococcus ruber. Binary 16S rDNA sequence for the pair AS4.1186 and Saccharothrix texasensis NRRL B-16134T, and the pair AS4.1187 and Rhodococcus ruber DSM 43338T exhibited 99.3% and 99.5% similarity, respectively. Corresponding DNA-DNA reassociation values were significantly higher than 70%, 77.6% and 82.9%, respectively. Results of chemotaxonomic analyses of cell wall, mycolic acid, principal menaquinones, phospholipid type and the G + C content of the DNA supported the conclusions of the genotypic analyses. The very similar morphological and physiological characteristics agreed with the high degree of relatedness. On the basis of phylogenetic analyses, DNA-DNA reassociation values, chemotaxonomic properties, morphological and physiological characteristics, it is concluded that strain AS4.1186 and AS4.1187 should be removed from the genus Nocardia. We propose to transfer Nocardia nostocoides AS4.1186 to the genus Saccharothrix, combine with the species S. texasensis, and combine Nocardia salmonicolor var. aurantiaca AS4.1187 with the species Rhodococcus ruber.

Actinomycetales↗

Study on the pathogenicity of some Nocardia spp isolated from tap water of Ismailia City, Egypt.

All actinomycetes isolated from canal water, Ismailia water plant and tap water were identified into 5 genera. All Nocardia isolates were identified into 3 species. Two of which, Nocardia transvalensis and Nocardia otitidus-caviarus were recorded in tap water. These species are pathogenic for human kind and animals. The pathogenicity of these isolates was tested on Swiss Albino mice. Symptomatic changes and death of mice inoculated with Nocardia suspension were recorded. The main symptoms were erythema, enduration and inflammation together with abcesses and an increase in the size of the spleen (spleenomegally). It is concluded from these experiments that: i) All Nocardia species isolated from tap water are pathogenic, at least for mice, ii) these isolates could present health hazards to human kind and needs an urgent investigation.

Animals↗

Physiological and pathogenic characteristics of Nocardia brasiliensis isolated from human mycetomas.

A previous analysis of the physiological properties of Nocardia brasiliensis strains isolated from soil of Tucumán proves that non-pathogenic strains have a different behaviour pattern from the pathogenic strains. In the present paper, 16 Nocardia brasiliensis strains isolated from human mycetomas were studied in the same way. The object is to determine if any of the Nocardia brasiliensis present in soil can produce human mycetomas. The macro and micromorphological, biochemical (17 tests), physiological (4 tests) and pathological characteristics were determined for each of the strains. Experimental pathogenicity was determined using albino Swiss mice by inoculation into the footpads. The strains of Nocardia brasiliensis that cause human mycetomas have the same physiological pattern and experimental pathogenicity as the virulent strains present in soil.

Animals↗

Bacteriophages of Nocardia asteroides.

101 Nocardia strains from different species and different sources were examined with respect to their lysogeny. 18 phages from 17 Nocardia asteroides strains could be isolated, purified, and propagated. All phages were released spontaneously. Induction experiments with mitomycin C and UV-rays brought no practicale advantages. Using 14 of the 18 phages, 38 of the 101 Nocardia strains tested could be grouped into 18 phage patterns. Nearly all of the typable strains belonged to the species Nocardia asteroides.

Bacteriophage Typing↗

Unilateral vocal cord paralysis as a result of a Nocardia farcinica laryngeal abscess.

Nocardia farcinica is an emerging pathogen in immunocompromised hosts, accounting for 20% of Nocardia isolates in the USA and 13-44% of isolates in Europe. The case of a 72-year-old lymphoma patient with a laryngeal abscess caused by Nocardia farcinica is presented. The initial clinical manifestation was unilateral vocal cord paralysis, which improved following surgical drainage of the abscess and therapy with imipenem. The English-language literature on human Nocardia farcinica infection is reviewed.

Abscess↗

Nocardia keratitis in a human immunodeficiency virus patient.

BACKGROUND: The development of Nocardia keratitis in a patient with human immunodeficiency virus infection is rare, and we could find no cases reported in the literature. CASE: A 48-year-old woman who had human immunodeficiency virus infection presented with decreased visual acuity, redness, and irritation in the right eye. OBSERVATIONS: Initially, the diagnosis was fungal keratitis, and she was treated with 0.3% amphotericin B eye drops and oral fluconazole for 1 month without improvement. Then, all former drugs were discontinued, and a corneal scraping was carried out. The culture result disclosed Nocardia asteroides, and after treatment with 10% sulfacetamide eye drops and oral trimethoprim-sulfamethoxazole, the keratitis subsided dramatically. CONCLUSIONS: The treatment result for Nocardia keratitis in a human immunodeficiency virus patient was favorable after intensive use of 10% sulfacetamide eyedrops. Nocardia keratitis should be kept in mind as a possible causative organism when antifungal therapy fails in a keratitis case.

Administration, Oral↗

Epidemiology, bacteriology and control of an outbreak of Nocardia asteroides infection on a liver unit.

An outbreak of Nocardia asteroides infection affecting seven patients is described. Over a 5-week period, five patients with liver disease admitted to a ward developed clinical and laboratory evidence of nocardiosis, and two further cases were diagnosed 3 and 5 months later. Three out of the five patients who received specific antimicrobial therapy responded to treatment; in three patients nocardia infection was considered to have contributed to death. In six out of the seven patients, nocardiosis followed immunosuppression. A common-source outbreak was considered to be responsible for infection in the first five patients. In two patients, presentation of infection 5 and 7 months after the first case may have been due to prolonged colonization or subclinical infection with Nocardia. Biotyping of the seven isolates using a fluorogenic biochemical method identified three distinct strains of N. asteroides. The most probable source of Nocardia was contaminated brick and plaster dust arising from building work in an area adjacent to the ward. However, samples of air, dust and water failed to yield N. asteroides. Infection control measures included ward closure followed by thorough cleaning, and formaldehyde fumigation.

Adult↗