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O'Brien A, Hart J, Higgins A, Arthur I, Lee GH, Leung M, Kennedy K, Bradbury S, Foster S, Warren S, Korman TM, Abbott IJ, Heney C, Bletchley C, Warner M, Wells N, Wilson D, Varadhan H, Stevens R, Lahra M, Newton P, Maley M, van Hal S, Ingram PR. Nocardia species distribution and antimicrobial susceptibility within Australia. Intern Med J 2024; 54:613-619. [PMID: 37929813 DOI: 10.1111/imj.16234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/29/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Nocardia is a ubiquitous saprophyte capable of causing human disease. Disease is primarily respiratory or cutaneous, usually acquired via inhalation or inoculation. Under the influence of environmental and host factors, Nocardia incidence and species distribution demonstrate geographical variation. AIMS To examine for differences in Nocardia incidence within Western Australia (WA) and analyse species distribution in the context of prior published studies. To analyse antibiogram data from a nationwide passive antimicrobial resistance surveillance program. METHODS Retrospective extraction of laboratory data for Western Australian Nocardia isolates over a 21-year period. Analysis of Nocardia antimicrobial susceptibility testing data submitted to the Australian Passive Antimicrobial Resistance Surveillance (APAS) program between 2005 and 2022. RESULTS Nine hundred sixty WA isolates were identified, giving an annual incidence of 3.03 per 100 000 population with apparent latitudinal variation. The four most common species identified within WA and amongst APAS isolates were N. nova, N. cyriacigeorgica, N. brasiliensis and N. farcinica. APAS data demonstrated that all species exhibited high rates of susceptibility to linezolid (100%) and trimethoprim-sulfamethoxazole (98%). Amikacin (>90% susceptibility for all species except N. transvalensis) was the next most active parenteral agent, superior to both carbapenems and third-generation cephalosporins. Susceptibility to oral antimicrobials (other than linezolid) demonstrated significant interspecies variation. CONCLUSIONS We demonstrate geographical variation in the distribution of Nocardia incidence. Four species predominate in the Australian setting, and nationwide data confirm a high in vitro susceptibility to trimethoprim-sulphamethoxazole and linezolid, justifying their ongoing role as part of first-line empiric therapy.
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Affiliation(s)
- Aine O'Brien
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Julie Hart
- Department of Infectious Diseases, Sir Charles Gardiner Hospital, Perth, Western Australia, Australia
| | - Ammie Higgins
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Ian Arthur
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Gar-Hing Lee
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Michael Leung
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Karina Kennedy
- ACT Health, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Susan Bradbury
- ACT Health, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Sarah Foster
- Launceston General Hospital, Tasmanian Health Service (THS), Hobart, Tasmania, Australia
| | - Sanchia Warren
- Royal Hobart Hospital, Department of Microbiology and Infectious Diseases, Hobart, Tasmania, Australia
| | - Tony M Korman
- Monash Health, Monash Infectious Diseases, Melbourne, Victoria, Australia
| | | | - Claire Heney
- Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | | | - Morgyn Warner
- Infectious Diseases and Microbiology Department, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Nicholas Wells
- South Australia Pathology, Adelaide, South Australia, Australia
| | - Desley Wilson
- South Australia Pathology, Adelaide, South Australia, Australia
| | - Hemalatha Varadhan
- Hunter New England, NSW Health Pathology, Newcastle, New South Wales, Australia
| | - Robert Stevens
- South Eastern Sydney, NSW Health Pathology, Sydney, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Monica Lahra
- NSW Health Pathology, Newcastle, New South Wales, Australia
| | - Peter Newton
- Illawarra-Shoalhaven, NSW Health Pathology, Wollongong, New South Wales, Australia
| | - Michael Maley
- South Western Sydney, NSW Health Pathology, Sydney, New South Wales, Australia
- Microbiology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Sebastian van Hal
- NSW Health Pathology, Newcastle, New South Wales, Australia
- Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Paul R Ingram
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Hu Y, Zhu Y, Li C, Shi H, Zhang Y, Zhao J, Fan Y, Wu Y, Li Z, Liu X, Zhang F, Lu B. Evaluation of BACTEC MGIT 960 system for recovery of Nocardia from clinical specimens. Diagn Microbiol Infect Dis 2023; 106:115989. [PMID: 37269756 DOI: 10.1016/j.diagmicrobio.2023.115989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/09/2023] [Accepted: 05/09/2023] [Indexed: 06/05/2023]
Abstract
Nocardia spp. is an aerobic Gram-positive bacillus responsible for nocardiosis. Herein, we performed a retrospective study to evaluate the performance of BACTEC MGIT 960 system, in comparison with smear microscopy and blood agar plate (BAP) culture, to recover Nocardia from different clinical specimens. Furthermore, the inhibitory effect of antibiotics contained in MGIT 960 tube on Nocardia was also evaluated. The sensitivities for Nocardia recovery using smear microscopy, BAP culture, and MGIT 960 were 39.4% (54/137), 46.1% (99/215), and 81.3% (156/192), respectively. N. farcinica was the most detected species (60.4%, 136/225). In MGIT 960-recovered Nocardia strains, N. farcinica accounted for 76.9%. Furthermore, trimethoprim in MGIT 960 tube inhibited less N. farcinica growth than that of other Nocardia species, partially explaining why MGIT 960 recovered more N. farcinica from sputa. The current study demonstrated that MGIT 960 could recover Nocardia strains from heavily-contaminated samples if its components and antibiotics are redesigned.
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Affiliation(s)
- Yanning Hu
- Peking University China-Japan Friendship School of Clinical Medicine, Peking University Health Science Center, Beijing, China; Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yue Zhu
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Li
- Peking University China-Japan Friendship School of Clinical Medicine, Peking University Health Science Center, Beijing, China; Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; Department of Clinical Laboratory, Liuyang Traditional Chinese Medicine Hospital, Changsha, Hunan, China
| | - Huihui Shi
- Department of Clinical Laboratory, Affiliated Nantong Hospital of Shanghai University, Nantong, China
| | - Yulin Zhang
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiankang Zhao
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanyan Fan
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yongli Wu
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ziyao Li
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital
| | - Xinmeng Liu
- Peking University China-Japan Friendship School of Clinical Medicine, Peking University Health Science Center, Beijing, China; Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Feilong Zhang
- Peking University China-Japan Friendship School of Clinical Medicine, Peking University Health Science Center, Beijing, China; Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Binghuai Lu
- Peking University China-Japan Friendship School of Clinical Medicine, Peking University Health Science Center, Beijing, China; Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital.
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3
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Kogure M, Takase E, Fusamoto A, Sato K, Tsuchihashi Y, Nakanishi H, Ikeda T, Kuchibiro T, Hirai Y, Kanai K. Treatment of refractory localized pulmonary nocardiosis caused by Nocardia mexicana with a combination of medication and surgery. Respirol Case Rep 2023; 11:e01098. [PMID: 36789173 PMCID: PMC9909781 DOI: 10.1002/rcr2.1098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
Pulmonary nocardiosis is a rare disease that is often difficult to cure because of its tendency to recur. Here, we report a case of refractory localized pulmonary nocardiosis caused by Nocardia mexicana. A 60-year-old Japanese woman had recurring pulmonary nocardiosis four times previously and each time she was treated with antibiotics for a sufficient duration; nevertheless, the disease continued to recur, probably because of resistance to antibiotics. As a fifth treatment, we performed middle lobe resection and pre- and post-operative antimicrobial therapy for 6 months. The combination of medication and surgery was useful for treating refractory localized pulmonary nocardiosis.
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Affiliation(s)
- Miwako Kogure
- Department of Respiratory MedicineNaga Municipal HospitalKinokawaWakayamaJapan
| | - Eri Takase
- Department of Respiratory MedicineNaga Municipal HospitalKinokawaWakayamaJapan
| | - Aya Fusamoto
- Department of Breast and General Thoracic SurgeryNaga Municipal HospitalKinokawaWakayamaJapan
| | - Koichi Sato
- Department of Respiratory MedicineNaga Municipal HospitalKinokawaWakayamaJapan
| | - Yukiko Tsuchihashi
- Department of Respiratory MedicineNaga Municipal HospitalKinokawaWakayamaJapan
| | - Hirotaka Nakanishi
- Department of Respiratory MedicineNaga Municipal HospitalKinokawaWakayamaJapan
| | - Takeshi Ikeda
- Department of Respiratory MedicineNaga Municipal HospitalKinokawaWakayamaJapan
| | - Tomokazu Kuchibiro
- Department of Clinical LaboratoryNaga Municipal HospitalKinokawaWakayamaJapan
| | - Yoshimitsu Hirai
- Department of Breast and General Thoracic SurgeryNaga Municipal HospitalKinokawaWakayamaJapan
| | - Kuninobu Kanai
- Department of Respiratory MedicineNaga Municipal HospitalKinokawaWakayamaJapan
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4
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Siavashifar M, Rezaei F, Motallebirad T, Azadi D, Absalan A, Naserramezani Z, Golshani M, Jafarinia M, Ghaffari K. Species diversity and molecular analysis of opportunistic Mycobacterium, Nocardia and Rhodococcus isolated from the hospital environment in a developing country, a potential resources for nosocomial infection. Genes Environ 2021; 43:2. [PMID: 33509299 PMCID: PMC7844956 DOI: 10.1186/s41021-021-00173-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Hospital environmental resources have a significant role in cross-transmission of opportunistic pathogens such as actinomycetes species to the patients. Actinomycetes have a remarkable capability to survive in adverse and harsh conditions of hospital environments; therefore, they are a threat to the health of patients. Due to this issue, we aimed to determine the frequency and diversity of actinomycetes species in hospital soil, water and dust by using a combination of conventional and molecular methods including the phenotypic and biochemical tests for preliminary identification and the PCR amplification of the specific region of the 16S rRNA, hsp65 gene and sequence analyses of 16S rRNA for the genus and species identification. Results A total of 50 (35.2%) actinomycetes isolates from 7 genera were isolated from 142 hospital environmental samples. The three most prevalent species were M. setense 10%, R. erythropolis and M. fortuitum 8% followed by N.cyriacigeorgica and M. gordonae 6%, M. chelonae, M. abscessus, M. lentiflavum, M. mucogenicum, N. asteroides, N. farcinica, R. equi and L. shinushuensis 4% and the single isolates of M. conceptionense, M. septicum, N. rhamnosophilia, N. bravicatena, M. flavescens, M. arupense, M. doricum, M. frederiksbergense, S. heliomycini, S. albus, S. albogriseolus, R. facians, D. maris, G. terae and A. globiformis. Conclusions In conclusion we showed that the hospital environment is a potential reservoir for a broad range of actinomycetes species, due to the remarkable survival capability of these microorganisms in adverse hospital environment, carrying a threat to the health of patients.
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Affiliation(s)
- Marzieh Siavashifar
- Student Research Comitee, Khomein University of Medical Sciences, Khomein, Iran
| | - Fatemeh Rezaei
- Student Research Comitee, Khomein University of Medical Sciences, Khomein, Iran
| | - Tahereh Motallebirad
- Department of Basic and Laboratory and Sciences, Khomein University of Medical Sciences, Qods street, Khomein, Iran
| | - Davood Azadi
- Department of Basic and Laboratory and Sciences, Khomein University of Medical Sciences, Qods street, Khomein, Iran.
| | - Abdorrahim Absalan
- Department of Basic and Laboratory and Sciences, Khomein University of Medical Sciences, Qods street, Khomein, Iran
| | - Zahra Naserramezani
- Student Research Comitee, Khomein University of Medical Sciences, Khomein, Iran
| | - Mohadeseh Golshani
- Student Research Comitee, Khomein University of Medical Sciences, Khomein, Iran
| | - Morteza Jafarinia
- Department of Immunology, School of Medicine, Isfahan University Of Medical Sciences, Isfahan, Iran
| | - Kazem Ghaffari
- Department of Basic and Laboratory and Sciences, Khomein University of Medical Sciences, Qods street, Khomein, Iran
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5
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Azadi D, Motallebirad T, Ghaffari K, Shokri D, Rezaei F. Species Diversity, Molecular Characterization, and Antimicrobial Susceptibility of Opportunistic Actinomycetes Isolated from Immunocompromised and Healthy Patients of Markazi Province of Iran. Infect Drug Resist 2020; 13:1-10. [PMID: 32021315 PMCID: PMC6954848 DOI: 10.2147/idr.s234292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/13/2019] [Indexed: 12/17/2022] Open
Abstract
Background Actinomycetes widely exist in nature and these species cause infections in immunocompromised and healthy patients, although they are frequently found as members of the normal microbiota of humans and animals. These subsequent infections are often misdiagnosed as malignancy and tuberculosis. Due to this issue, the present study aimed to determine the presence and diversity of actinomycetes species causing infections in Iranian patients. Materials and Methods A total of 79 clinical samples collected from five hospitals in Markazi province were analyzed for the existence of actinomycetes using standard protocols for isolation and characterization of the isolates. The conventional tests were used for preliminary identification, the PCR amplification of hsp65 gene, the specific region of the 16S rRNA, and sequence analyses of 16S rRNA were applied for the genus and species identification. MICs of the antimicrobial agent were determined by the broth microdilution method and interpreted according to the NCCLS guidelines. Results A total of 17 (21.51%) actinomycetes isolates were recovered from clinical samples. In other analyzed samples, eight (10.12%) gram-positive, 12 (15.18) gram-negative bacteria, and six (7.6) fungi isolates were recovered. The most prevalent actinomycetes species were M. fortuitum (17.64%), N. Mexicana and S. heliomycini (11.76% each), and 10 species, ie, N. farcinica, M. lehmannii, M. flavescens, Arthrobacter crystalopoetis, N. neocaledoniensis, M. phocaicum, M. abscessus, M. arupense, M. setense, and N. cyriacigeorgica made up the single isolates. Results of DST illustrated that all of the isolates were susceptible to Amikacin, Levofloxacin, Ofloxacin, and Ciprofloxacin, whereas all of them were resistant to Rifampicin and Doxycycline. Conclusion In conclusion, increasing isolation of actinomycetes found in various clinical cases merits special attention by health authorities in developing countries. In health centers, action should be taken to increase awareness of appropriate diagnostic criteria and management guidelines for actinomycetes diseases. Furthermore, an increase in the number as well as the quality of national and regional reference laboratories may facilitate more accurate diagnosis of actinomycetes diseases.
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Affiliation(s)
- Davood Azadi
- Department of Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran.,Molecular Medicine Research Center, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Tahereh Motallebirad
- Department of Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran
| | - Kazem Ghaffari
- Department of Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran
| | - Dariuosh Shokri
- Department of Biology and Microbiology, Shahid Ashrafi Isfahani University, Isfahan, Iran
| | - Fatemeh Rezaei
- Department of Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran
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Kurosawa S, Sekiya N, Doki N, Yaguchi T, Kishida Y, Nagata A, Yamada Y, Konishi T, Kaito S, Yoshifuji K, Shirane S, Uchida T, Inamoto K, Toya T, Igarashi A, Najima Y, Muto H, Kobayashi T, Kakihana K, Sakamaki H, Ohashi K. The emergence of rare nocardiosis following allogeneic hematopoietic stem cell transplantation in the era of molecular taxonomy. Int J Infect Dis 2019; 89:154-162. [PMID: 31605809 DOI: 10.1016/j.ijid.2019.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE The purpose of this study was to describe the clinical features of nocardiosis after allogeneic hematopoietic stem cell transplantation (allo-HSCT), focusing on new Nocardia species. METHODS We retrospectively reviewed data from patients with nocardiosis after allo-HSCT treated at our hospital and documented cases in the medical literature. RESULTS Fifty-seven cases were identified from our institution and the literature review. Although 51 patients (89.5%) responded to initial treatment, 28 (49.1%) patients were switched over to other treatment regimens due to the recurrence of nocardiosis or adverse events of antimicrobials. Nocardiosis-attributed mortality occurred in ten patients (17.5%). Antimicrobial susceptibilities varied among intra- and inter-species except linezolid (LZD). In the present study, five species were newly discovered after 2000, including N. cyriacigeorgica, N. veterana, N. abscessus, N. aobensis, and N. mexicana. All isolates of N. cyriacigeorgica, N. veterana, N. abscessus, and N. aobensis were sensitive to trimethoprim/sulfamethoxazole, amikacin (AMK), imipenem (IPM), and LZD; however, N. mexicana was resistant to AMK and IPM. CONCLUSION Newly identified Nocardia species have various antimicrobial susceptibility patterns. Long-term maintenance therapy could be challenging due to the adverse events of antimicrobials, especially in the allo-HSCT setting. Prudent evaluation is crucial for selecting a second-line or further treatment options.
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Affiliation(s)
- Shuhei Kurosawa
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Noritaka Sekiya
- Department of Infection Prevention and Control, Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan.
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | | | - Yuya Kishida
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Akihito Nagata
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Yuta Yamada
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Tatsuya Konishi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Satoshi Kaito
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Kota Yoshifuji
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Shuichi Shirane
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Tomoyuki Uchida
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Kyoko Inamoto
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Takashi Toya
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Aiko Igarashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Yuho Najima
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Hideharu Muto
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Takeshi Kobayashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Kazuhiko Kakihana
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Hisashi Sakamaki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Kazuteru Ohashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
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7
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Shokri D, Motalebirad T, Jafarinia M, Azadi D, Ghaffari K. First case report of pulmonary and cutaneous nocardiosis caused by Nocardia mexicana in Iran. Access Microbiol 2019; 1:e000016. [PMID: 32974520 PMCID: PMC7470292 DOI: 10.1099/acmi.0.000016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 02/20/2019] [Indexed: 11/21/2022] Open
Abstract
Background Nocardia are aerobic partially acid-fast bacteria that are environmentally ubiquitous. This group of bacteria causes a rare bacterial infection of either the lungs (pulmonary) or body (systemic) that usually affects immunocompromised individuals. Nocardia mexicana was first isolated in 2004 from a patient with chronic bronchitis. However, there have been few reports on the clinical significance of this organism up to now. We herein report the first cases of N. mexicana in patients with pulmonary and cutaneous infection from Iran. Case presentation A 57-year-old man was admitted to hospital due to a cutaneous wound on his left foot, fever, weakness, persistent cough and chest pain. At first, due to clinical examination and laboratory test, the patient was diagnosed as having tuberculosis. However, PCR of Mycobacterium tuberculosis was negative from broncho-alveolar lavage (BAL) samples. Direct PCR of BAL was performed for this patient and according to the clinical examinations and microbiological evaluations; the micro-organism was identified as N. mexicana and was isolated from both BAL and the wound. Finally, the patient was treated with linezolid and amikacin. Conclusion The infections, with actinomycetes such as Nocardia, are easily neglected or misdiagnosed due to the fastidious nature of the organism and the inadequate microbiological experience of laboratories in the hospitals of developing countries. This case shows that hospitals should consider a better laboratory protocol to deal with the clinical cases in which fastidious organisms, and in particular Nocardia, are involved.
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Affiliation(s)
- Darioush Shokri
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tahereh Motalebirad
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Morteza Jafarinia
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Azadi
- Molecular and Medicine Research Center, Arak University of Medical Sciences, Arak, Iran.,Department of Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran
| | - Kazem Ghaffari
- Department of Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran
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8
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DeWitt JP, Stetson CL, Thomas KL, Carroll BJ. Extensive Cutaneous Botryomycosis With Subsequent Development of Nocardia-Positive Wound Cultures. J Cutan Med Surg 2018; 22:344-346. [PMID: 29366337 DOI: 10.1177/1203475418755762] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Botryomycosis is a rare, chronic granulomatous infection caused by a response to bacteria, most commonly Staphylococcus aureus. Cutaneous manifestations, such as subcutaneous nodules, nonhealing ulcers, or sinus tracks, typically occur following inoculation of bacteria after trauma. Drainage from the skin lesions may contain yellow grains resembling those seen in actinomycosis and nocardiosis. A 20-year-old Hispanic male presented over the course of several years with a chronic nonhealing left posterior scalp wound. A car hit the patient when he was 2 years old and injured the scalp in the location of the skin lesion. Multiple wound cultures grew methicillin-resistant Staphylococcus aureus (MRSA), and biopsies were consistent with botryomycosis. He was treated with multiple surgical debridements, skin grafts, and various courses of oral and intravenous antibiotics with slight improvement. One reason for poor response to therapy was noncompliance with long-term home antibiotics. The most recent tissue culture grew MRSA in addition to Nocardia mexicana, and he experienced improvement on linezolid and minocycline. Although it is important to exclude nocardiosis and actinomycosis when diagnosing botryomycosis, our patient was diagnosed with botryomycosis after multiple biopsies and positive MRSA cultures 2 years prior to 1 positive N mexicana culture. Our case is a unique presentation of botryomycosis in an individual who subsequently developed Nocardia-positive wound cultures.
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Affiliation(s)
- Judy Park DeWitt
- 1 School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Cloyce L Stetson
- 2 Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Kleesy L Thomas
- 2 Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Bryan J Carroll
- 2 Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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9
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McHugh KE, Sturgis CD, Procop GW, Rhoads DD. The cytopathology of Actinomyces, Nocardia, and their mimickers. Diagn Cytopathol 2017; 45:1105-1115. [PMID: 28888064 DOI: 10.1002/dc.23816] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/08/2017] [Accepted: 08/29/2017] [Indexed: 12/27/2022]
Abstract
Nocardia species and Actinomyces species are 2 of the most commonly diagnosed filamentous bacteria in routine cytopathology practice. These genera share many overlapping cytomorphologic features, including their thin, beaded, branching, Gram-positive, GMS-positive filamentous structures that fragment at their peripheries into bacillary- and coccoid-appearing forms. Features that help distinguish between these 2 microorganisms include the width of their filamentous structures, the angles at which they branch, and their ability or lack thereof to retain a modified acid-fast stain. In addition to cytomorphologic overlap, overlap in clinical presentation is frequent with pulmonary and mucocutaneous presentations seen in both. Differentiating between Nocardia and Actinomyces is essential because patients with these infections require different approaches to medical management. Both antibiotic susceptibilities and the need for early surgical intervention as part of the treatment plan vary greatly among these 2 groups. This review focuses on the clinical presentation, cytomorphology and staining characteristics that can be useful in identifying and distinguishing between Nocardia and Actinomyces infections, as well as their mimickers.
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Affiliation(s)
- Kelsey E McHugh
- Department of Laboratory Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio, 44195
| | - Charles D Sturgis
- Department of Laboratory Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio, 44195
| | - Gary W Procop
- Department of Laboratory Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio, 44195
| | - Daniel D Rhoads
- Department of Pathology, Case Western Reserve University, 10900 Euclid Ave, Cleveland, Ohio, 44106.,Department of Pathology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, Ohio, 44106
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Intractable cerebral Nocardia mexicana in a GvHD patient successfully treated with linezolid. Bone Marrow Transplant 2017; 52:1476-1478. [DOI: 10.1038/bmt.2017.167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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