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Nocardia: la gran simuladora. Enferm Infecc Microbiol Clin 2021; 39:159-160. [DOI: 10.1016/j.eimc.2020.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 11/21/2022]
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Martínez-Barricarte R. Isolated Nocardiosis, an Unrecognized Primary Immunodeficiency? Front Immunol 2020; 11:590239. [PMID: 33193422 PMCID: PMC7606290 DOI: 10.3389/fimmu.2020.590239] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/31/2020] [Indexed: 01/19/2023] Open
Abstract
Nocardiosis is an infectious disease caused by the gram-positive bacterium Nocardia spp. Although it is commonly accepted that exposure to Nocardia is almost universal, only a small fraction of exposed individuals develop the disease, while the vast majority remain healthy. Nocardiosis has been described as an "opportunistic" disease of immunocompromised patients, suggesting that exposure to the pathogen is necessary, but a host predisposition is also required. Interestingly, increasing numbers of nocardiosis cases in individuals without any detected risk factors, i.e., without overt immunodeficiency, are being reported. Furthermore, a growing body of evidence have shown that selective susceptibility to a specific pathogen can be caused by a primary immunodeficiency (PID). This raises the question of whether an undiagnosed PID may cause nocardiosis affecting otherwise healthy individuals. This review summarizes the specific clinical and microbiological characteristics of patients with isolated nocardiosis published during the past 30 years. Furthermore, it gives an overview of the known human immune mechanisms to fend off Nocardia spp. obtained from the study of PIDs and patients under immunomodulatory therapies.
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Affiliation(s)
- Rubén Martínez-Barricarte
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Pathology, Microbiology, and Immunology, Vanderbilt Center for Immunobiology, Vanderbilt Institute for Infection, Immunology, and Inflammation, Vanderbilt University Medical Center, Nashville, TN, United States
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Nouioui I, Cortés-Albayay C, Neumann-Schaal M, Vicente D, Cilla G, Klenk HP, Marimón JM, Ercibengoa M. Genomic Virulence Features of Two Novel Species Nocardia barduliensis sp. nov. and Nocardia gipuzkoensis sp. nov., Isolated from Patients with Chronic Pulmonary Diseases. Microorganisms 2020; 8:microorganisms8101517. [PMID: 33019781 PMCID: PMC7600791 DOI: 10.3390/microorganisms8101517] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/15/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022] Open
Abstract
Strains 335427T and 234509T, isolated from two 76-year-old patients with chronic pulmonary diseases, were the subject of polyphasic taxonomic studies and comparative genomic analyses for virulence factors. The 16 rRNA gene sequence similarity between strains 335427T and 234509T and their closest phylogenetic neighbors Nocardia asiatica NBRC 100129T and Nocardia abscessus NBRC 100374T were 99.5% and 100%, respectively. Digital DNA-DNA hybridization values between the aforementioned studied strains were well below the 70% threshold for assigning prokaryotic strains to a novel species. Strains 335427T and 234509T have genome sizes of 8.49 Mpb and 8.07 Mpb, respectively, with G + C content of 68.5%. Isolate 335427T has C16:0, C18:1 ω9c, C18:0 and C18:0 10 methyl as major fatty acids (>15%) and mycolic acids formed of 52-54 carbon atoms. However, only C18:1 ω9c was detected for isolate 234509T, which had mycolic acids with 44-56 carbon. Based on phenotypic and genetic data, strains 335427T (DSM 109819T = CECT 9924T) and 234509T (DSM 111366T = CECT 30129T) merit recognition as novel species, which are named Nocardia barduliensis sp. nov. and Nocardia gipuzkoensis sp. nov., respectively. All the strains studied had homologous VF-associated genes to those described in M. tuberculosis, including experimentally verified virulence genes in humans related to tuberculosis. The narGHIJ (nitrate reduction pathway) and gvpAFGOJLMK (gas vesicles) genetic maps of strains 335427T, 234509T, NBRC 100129T and NBRC 100374T showed the same syntenic block and raise the question of whether their functions are interlinked during the infection of the human host. However, further research is required to decipher the role of the gas vesicle in the pathogenicity mechanism of Nocardia spp.
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Affiliation(s)
- Imen Nouioui
- Leibniz Institute DSMZ–German Collection of Microorganisms and Cell Cultures, 38124 Braunschweig, Germany;
- Correspondence: (I.N.); (M.E.)
| | - Carlos Cortés-Albayay
- Laboratory of Microbial Complexity and Functional Ecology, Antofagasta Institute, University of Antofagasta, Antofagasta 1240000, Chile;
| | - Meina Neumann-Schaal
- Leibniz Institute DSMZ–German Collection of Microorganisms and Cell Cultures, 38124 Braunschweig, Germany;
| | - Diego Vicente
- Biodonostia, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group; Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Microbiology Department, 20014 San Sebastian, Spain; (D.V.); (G.C.); (J.M.M.)
| | - Gustavo Cilla
- Biodonostia, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group; Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Microbiology Department, 20014 San Sebastian, Spain; (D.V.); (G.C.); (J.M.M.)
| | - Hans-Peter Klenk
- School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
| | - Jose María Marimón
- Biodonostia, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group; Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Microbiology Department, 20014 San Sebastian, Spain; (D.V.); (G.C.); (J.M.M.)
| | - Maria Ercibengoa
- Biodonostia, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group; Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Microbiology Department, 20014 San Sebastian, Spain; (D.V.); (G.C.); (J.M.M.)
- Correspondence: (I.N.); (M.E.)
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Faircloth EL, Troy P. A Rare Presentation of Nocardia pericarditis Leading to Cardiac Tamponade in an Immunocompetent Patient. Cureus 2019; 11:e4140. [PMID: 31058023 PMCID: PMC6485539 DOI: 10.7759/cureus.4140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Nocardia can cause isolated disease in many parts of the body including the brain, skin, and lungs. It is also capable of causing disseminated disease. In almost all cases, Nocardia infections occur in immunocompromised hosts with depressed cell-mediated functions. We present a case of disseminated Nocardia farcinica leading to pericardial effusion and tamponade in an immunocompetent host with the only risk factor being heavy alcohol intake. Treatment relies on an accurate diagnosis. This case presentation highlights the importance of considering Nocardia infections in an alcoholic patient with a worsening clinical picture.
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Sawai T, Nakao T, Yamaguchi S, Yoshioka S, Matsuo N, Suyama N, Yanagihara K, Mukae H. Detection of high serum levels of β-D-Glucan in disseminated nocardial infection: a case report. BMC Infect Dis 2017; 17:272. [PMID: 28407752 PMCID: PMC5390473 DOI: 10.1186/s12879-017-2370-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 03/30/2017] [Indexed: 11/24/2022] Open
Abstract
Background β-D-glucan (BDG) is a helpful diagnostic marker for many invasive fungal infections, but not for nocardiosis. Here, we reported the first case of nocardial infection with high serum level of BDG. Case presentation A 73-year-old man was hospitalized because of fever, headache, and appetite loss after 10 months of steroid and immunosuppressive therapy for cryptogenic organizing pneumonia. With a diagnosis of bacterial pneumonia, treatment with ampicillin/sulbactam was initiated. There was improvement on chest radiograph, but fever persisted. Further work-up revealed multiple brain abscesses on cranial magnetic resonance imaging (MRI). Serum galactomannan and BDG were elevated at 0.6 index and 94.7 pg/ml, respectively. Voriconazole was initiated for presumed aspergillus brain abscess. However, fever persisted and consciousness level deteriorated. Drainage of brain abscess was performed; based on the Gram stain and Kinyoun acid-fast stain, disseminated nocardiosis was diagnosed. Voriconazole was then shifter to trimethoprim/sulfamethoxazole. The presence of Nocardia farcinica was confirmed by the 16S rRNA gene sequence. Treatment course was continued; BDG level normalized after 1 month and cranial MRI showed almost complete improvement after 2 months. Conclusion BDG assay is widely used to diagnose invasive fungal infection; therefore, clinicians should be aware that Nocardia species may show cross-reactivity with BDG assay on serum.
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Affiliation(s)
- Toyomitsu Sawai
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center City Hospital, 6-39 Shinchi-machi, Nagasaki, 850-8555, Japan.
| | - Takumi Nakao
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center City Hospital, 6-39 Shinchi-machi, Nagasaki, 850-8555, Japan
| | - Shota Yamaguchi
- Department of Laboratory Medicine, Nagasaki Harbor Medical Center City Hospital, 6-39 Shinchi-machi, Nagasaki, Japan
| | - Sumako Yoshioka
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center City Hospital, 6-39 Shinchi-machi, Nagasaki, 850-8555, Japan
| | - Nobuko Matsuo
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center City Hospital, 6-39 Shinchi-machi, Nagasaki, 850-8555, Japan
| | - Naofumi Suyama
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center City Hospital, 6-39 Shinchi-machi, Nagasaki, 850-8555, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto-machi, Nagasaki, Japan
| | - Hiroshi Mukae
- Second Department of Internal Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto-machi, Nagasaki, Japan
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Sharma N, O’Hagan S. The role of oral co-trimoxazole in treating Nocardia farcinica keratitis-a case report. J Ophthalmic Inflamm Infect 2016; 6:23. [PMID: 27324239 PMCID: PMC4916113 DOI: 10.1186/s12348-016-0091-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 06/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nocardia farcinica is one of the more recently identified species of the Nocardia genus. Nocardia farcinica keratitis is a rare occurrence, with only eight previously reported cases. Semi-permeable rigid contact lens use was associated with one of these reported cases. We report the first case of extended wear soft contact-lens-related Nocardia farcinica keratitis and recommend a new treatment regime. FINDINGS A 47-year-old lady presented with a right eye keratitis after wearing her extended wear soft contact lenses for five continuous weeks. There was no history of trauma or swimming with contact lenses in. Empirical ciprofloxacin and tobramycin eye drops were not tolerated due to ocular surface irritation on application; and instead, empirical treatment was with chloramphenicol and fortified gentamicin 1.5 % eye drops. Corneal scrapings grew Nocardia farcinica after 3 weeks-sensitive to amikacin and co-trimoxazole. Treatment was changed to amikacin 2.5 % eye drops, resulting in partial resolution of the corneal infiltrates. Oral co-trimoxazole 160/800 mg BD was added, due to cultured drug sensitivity and its high ocular penetration, with good results and a final right eye best-corrected visual acuity of 6/5. CONCLUSION Nocardia farcinica keratitis should be considered in the differential diagnosis of contact-lens-related keratitis. We report the first case occurring in association with extended wear soft contact lenses. Nocardia species can mimic fungal and Acanthamoeba keratitis. Treatment with oral co-trimoxazole has not been previously reported. This case demonstrates a role for co-trimoxazole in treating Nocardia farcinica keratitis based on cultured drug sensitivities.
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Affiliation(s)
- Neharika Sharma
- Cairns Base Hospital, 165 The Esplanade, Cairns, Queensland 4870 Australia
| | - Stephen O’Hagan
- Cairns Base Hospital, 165 The Esplanade, Cairns, Queensland 4870 Australia
- James Cook University, 1 James Cook Drive, Townsville City, 4811 Queensland Australia
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Sharma N, O'Hagan S. The role of oral co-trimoxazole in treating Nocardia farcinica keratitis: a case report. J Ophthalmic Inflamm Infect 2016; 6:21. [PMID: 27294730 PMCID: PMC4905934 DOI: 10.1186/s12348-016-0087-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/30/2016] [Indexed: 12/03/2022] Open
Abstract
Nocardia farcinica is one of the more recently identified species of the Nocardia genus. Nocardia farcinica keratitis is a rare occurrence, with only eight previously reported cases. Semi-permeable rigid contact lens use was associated with one of these reported cases. We report the first case of an extended wear soft contact lens-related Nocardia farcinica keratitis and recommend a new treatment regime. A 47-year-old lady presented with a right eye keratitis after wearing her extended wear soft contact lenses for five continuous weeks. There was no history of trauma or swimming with contact lenses in. Empirical ciprofloxacin and tobramycin eye drops were not tolerated due to ocular surface irritation on application, and instead, empirical treatment was with chloramphenicol and fortified gentamicin 1.5 % eye drops. Corneal scrapings grew Nocardia farcinica after 3 weeks-sensitive to amikacin and co-trimoxazole. Treatment was changed to amikacin 2.5 % eye drops, resulting in partial resolution of the corneal infiltrates. Oral co-trimoxazole 160 mg/800 mg BD was added, due to cultured drug sensitivity and its high ocular penetration, with good results and a final right eye best-corrected visual acuity of 6/5. Nocardia farcinica keratitis should be considered in the differential diagnosis of contact lens-related keratitis. We report the first case occurring in association with extended wear soft contact lenses. Nocardia species can mimic fungal and acanthamoeba keratitis. Treatment with oral co-trimoxazole has not been previously reported. This case demonstrates the role of co-trimoxazole in treating Nocardia farcinica keratitis based on cultured drug sensitivities.
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Affiliation(s)
- Neharika Sharma
- Cairns Base Hospital, 165 The Esplanade, Cairns, Queensland, Australia.
| | - Stephen O'Hagan
- Cairns Base Hospital, 165 The Esplanade, Cairns, Queensland, Australia
- James Cook University, 1 James Cook Drive, Townsville City, Queensland, Australia
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Samuel B, Fioravanti G, Smith A, Longo S, Axelband J. Nocardia as a Complication in a 30-year-old Immunocompromised Hispanic Woman. Lab Med 2016; 45:e166-9. [PMID: 25527610 DOI: 10.1309/lmco0gijwvjammdh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Bensson Samuel
- St.Luke's University Hospital and Health Network, Internal Medicine Department, Bethlehem, PA
| | - Gloria Fioravanti
- St.Luke's University Hospital and Health Network, Internal Medicine Department, Bethlehem, PA
| | - Alden Smith
- St.Luke's University Hospital and Health Network, Department of Pathology, Bethlehem, PA
| | - Santo Longo
- St.Luke's University Hospital and Health Network, Department of Critical Care, Bethlehem, PA
| | - Jennifer Axelband
- St.Luke's University Hospital and Health Network, Department of Critical Care, Bethlehem, PA
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Fatal Nocardia farcinica Bacteremia Diagnosed by Matrix-Assisted Laser Desorption-Ionization Time of Flight Mass Spectrometry in a Patient with Myelodysplastic Syndrome Treated with Corticosteroids. Case Rep Med 2013; 2013:368637. [PMID: 23690786 PMCID: PMC3652045 DOI: 10.1155/2013/368637] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 03/28/2013] [Indexed: 12/23/2022] Open
Abstract
Nocardia farcinica is a Gram-positive weakly acid-fast filamentous saprophytic bacterium, an uncommon cause of human infections, acquired usually through the respiratory tract, often life-threatening, and associated with different clinical presentations. Predisposing conditions for N. farcinica infections include hematologic malignancies, treatment with corticosteroids, and any other condition of immunosuppression. Clinical and microbiological diagnoses of N. farcinica infections are troublesome, and the isolation and identification of the etiologic agent are difficult and time-consuming processes. We describe a case of fatal disseminated infection in a patient with myelodysplastic syndrome, treated with corticosteroids, in which N. farcinica has been isolated from blood culture and identified by Matrix-Assisted Laser Desorption-Ionization Time of Flight Mass Spectrometry. The patient died after 18 days of hospitalization in spite of triple antimicrobial therapy. Nocardia farcinica infection should be suspected in patients with history of malignancy, under corticosteroid therapy, suffering from subacute pulmonary infection,and who do not respond to conventional antimicrobial therapy. Matrix-Assisted Laser Desorption-Ionization Time of Flight Mass Spectrometry can be a valuable tool for rapid diagnosis of nocardiosis.
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Mgode GF, Weetjens BJ, Nawrath T, Lazar D, Cox C, Jubitana M, Mahoney A, Kuipers D, Machang'u RS, Weiner J, Schulz S, Kaufmann SHE. Mycobacterium tuberculosis volatiles for diagnosis of tuberculosis by Cricetomys rats. Tuberculosis (Edinb) 2012; 92:535-42. [PMID: 22883935 DOI: 10.1016/j.tube.2012.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 07/16/2012] [Accepted: 07/18/2012] [Indexed: 10/28/2022]
Abstract
Tuberculosis (TB) diagnosis in regions with limited resources depends on microscopy with insufficient sensitivity. Rapid diagnostic tests of low cost but high sensitivity and specificity are needed for better point-of-care management of TB. Trained African giant pouched rats (Cricetomys sp.) can diagnose pulmonary TB in sputum but the relevant Mycobacterium tuberculosis (Mtb)-specific volatile compounds remain unknown. We investigated the odour volatiles of Mtb detected by rats in reference Mtb, nontuberculous mycobacteria, Nocardia sp., Streptomyces sp., Rhodococcus sp., and other respiratory tract microorganisms spiked into Mtb-negative sputum. Thirteen compounds were specific to Mtb and 13 were shared with other microorganisms. Rats discriminated a blend of Mtb-specific volatiles from individual, and blends of shared, compounds (P = 0.001). The rats' sensitivity for typical TB-positive sputa was 99.15% with 92.23% specificity and 93.14% accuracy. These findings underline the potential of trained Cricetomys rats for rapid TB diagnosis in resource-limited settings, particularly in Africa where Cricetomys rats occur widely and the burden of TB is high.
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Affiliation(s)
- Georgies F Mgode
- Department of Immunology, Max Planck Institute for Infection Biology, Charitéplatz 1, Campus Charité Mitte, D-10117 Berlin, Germany
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Ability of Cricetomys rats to detect Mycobacterium tuberculosis and discriminate it from other microorganisms. Tuberculosis (Edinb) 2012; 92:182-6. [DOI: 10.1016/j.tube.2011.11.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 11/23/2011] [Accepted: 11/26/2011] [Indexed: 11/23/2022]
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Naidoo D, Kumari S, Bux F. Characterization of Nocardia farcinica, a filamentous bacterium isolated from foaming activated sludge samples. WATER ENVIRONMENT RESEARCH : A RESEARCH PUBLICATION OF THE WATER ENVIRONMENT FEDERATION 2011; 83:527-531. [PMID: 21751711 DOI: 10.2175/106143010x12851009156565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The identification and characterization of filamentous bacteria and their association with specific plant operating conditions and influent characteristics has been hampered because of morphological variations and differences between process configurations. A study was conducted to isolate and characterize the predominant filamentous bacteria observed in a foaming activated sludge treatment plant. The predominant foam-forming filament was isolated and characterized using microscopic, biochemical and molecular techniques. The phylogenetic analysis of the 16S rRNA gene confirmed that it was Nocardia farcinica, a typical filamentous foam-foaming pathogenic bacterium which is not widely reported outside of South Africa. The bacterium used a variety of substrates for its growth and showed greater affinity to larger and slowly biodegradable compounds. The N. farcinica grew well at temperatures ranging from 12 to 30 degrees C in R2A medium and with a pH ranging from 5.5 to 8.0 and an NaCl concentration of 1 to 5%. This range of conditions shows that N. farcinica can withstand extreme conditions, which results in its proliferation in foaming samples.
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Affiliation(s)
- Dashika Naidoo
- Institute for Water and Wastewater Technology, Department of Biotechnology and Food Technology, Faculty of Applied Sciences, Durban University of Technology, Durban, South Africa
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Parande MV, Shinde RS, Mantur BG, Parande AM, Chandrashekhar MR, Aralikatti PS, Palled E. A fatal case of empyema thoracis by Nocardia farcinica in an immunocompromised patient. Indian J Med Microbiol 2011; 28:390-2. [PMID: 20966578 DOI: 10.4103/0255-0857.71831] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Empyema thoracis by Nocardia farcinica infection is uncommon. Here we report a rare and fatal infection in a 27-year-old HIV- seropositive male who presented with cough, expectoration, and breathlessness. Nocardia farcinica was isolated from sputum and pus from the pleural cavity. Confirmation of the isolate and minimum inhibitory concentrations (MIC) for various antibiotics was done at the Aerobic Actinomycetes Reference Laboratory, Centres for Disease Control and Prevention (CDC), Atlanta. Patient was treated with suitable antibiotics and antiretroviral drugs in spite of which he eventually succumbed to the disease.
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Affiliation(s)
- M V Parande
- Department of Microbiology, Belgaum Institute of Medical Sciences, Belgaum, Karnataka, India.
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Bittar F, Stremler N, Audié JP, Dubus JC, Sarles J, Raoult D, Rolain JM. Nocardia farcinica lung infection in a patient with cystic fibrosis: a case report. J Med Case Rep 2010; 4:84. [PMID: 20211000 PMCID: PMC2844380 DOI: 10.1186/1752-1947-4-84] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 03/08/2010] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Respiratory tract infections are the major causes of morbidity and mortality in patients with cystic fibrosis. Nocardia are rarely implicated in these infections and few reports of the involvement of this species are found in the literature. CASE PRESENTATION We describe a case of lung infection followed by chronic colonization of trimethoprim and sulfamethoxazole resistant Nocardia farcinica in a patient with cystic fibrosis. The chronic colonization of this uncommon bacterium in patients with cystic fibrosis was proved using a newly developed real-time polymerase chain reaction assay, which indicates that this bacterium, despite treatment, is difficult to eradicate. CONCLUSION Our case report confirms that this organism can be recovered in persons with cystic fibrosis. Its eradication is necessary especially if the patient is to undergo lung transplantation.
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Affiliation(s)
- Fadi Bittar
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), CNRS-IRD, UMR 6236, Faculté de Médecine et de Pharmacie, Université de la Méditerranée, Boulevard Jean Moulin, 13385 Marseille cedex 5, France.
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Abscess of adrenal gland caused by disseminated subacute Nocardia farcinica pneumonia. A case report and mini-review of the literature. BMC Infect Dis 2009; 9:194. [PMID: 19954528 PMCID: PMC2792227 DOI: 10.1186/1471-2334-9-194] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 12/02/2009] [Indexed: 01/18/2023] Open
Abstract
Background Infections caused by Nocardia farcinica are uncommon and show a great variety of clinical manifestations in immunocompetent and immunocompromised patients. Because of its unspecific symptoms and tendency to disseminate it may mimic the clinical symptoms and radiologic findings of a tumour disease and the diagnosis of nocardiosis can easily be missed, because there are no characteristic symptoms. Case presentation We present a case of an adrenal gland abscess caused by subacute disseminated N. farcinica pneumonia. Conclusion An infection with N. farcinica is potentially lethal because of its tendency to disseminate -particularly in the brain- and its high resistance to antibiotics. Awareness of this differential diagnosis allows early and appropriate treatment to be administered.
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McPhee L, Stogsdill P, Vella J. Nocardia farcinicapericarditis after kidney transplantation despite prophylaxis. Transpl Infect Dis 2009; 11:448-53. [DOI: 10.1111/j.1399-3062.2009.00413.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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17
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Contreras A, Sierra D, Sánchez A, Corrales J, Marco J, Paape M, Gonzalo C. Mastitis in small ruminants. Small Rumin Res 2007. [DOI: 10.1016/j.smallrumres.2006.09.011] [Citation(s) in RCA: 201] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Bocchino M, Paglia MG, Marruchella A, Contini S, Festa A, Saltini C. Molecular diagnosis of fatal Nocardia farcinica pneumonia in an HIV-negative patient. Respiration 2006; 75:461-5. [PMID: 16825752 DOI: 10.1159/000094390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Accepted: 04/05/2006] [Indexed: 11/19/2022] Open
Abstract
Nocardiosis is a rare and potentially life-threatening infection caused by several species of the Nocardia genus. Most cases occur in immunocompromised patients, and a delay in establishing the diagnosis is common due to the non-specific clinical presentations and the difficulty in cultivating Nocardia. Although the majority of pulmonary nocardiosis cases are caused by Nocardia asteroides, cases of human infection due to N. farcinica are increasingly diagnosed due to recent developments in taxonomy and diagnostic methods. N. farcinica is a separate species from N. asteroides and appears to be more virulent and resistant to antibiotics. Herein, we describe the case of a 65-year-old HIV-negative immunocompromised patient with a fulminant bilateral pulmonary nocardiosis while on empirical treatment with trimethoprim/sulfamethoxazole and imipenem. Post-mortem diagnosis of N. farcinica infection was performed by means of DNA amplification and sequencing of the 65-kDa bacterial heat shock protein.
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Affiliation(s)
- Marialuisa Bocchino
- Divisione Clinicizzata di Malattie Respiratorie, INMI L. Spallanzani IRCCS, Rome, Italy.
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Bernadich O, Arguis P, González J, Ramírez J. Mujer de 68 años con fiebre prolongada. Med Clin (Barc) 2006; 126:589-96. [PMID: 16756924 DOI: 10.1157/13087699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Oscar Bernadich
- Sección de Neumología, Hospital Sant Bernabé, Berga, Barcelona, España
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Ferrer A, Llorenç V, Codina G, de Gracia-Roldán J. Nocardiosis y bronquiectasias. ¿Una asociación infrecuente? Enferm Infecc Microbiol Clin 2005; 23:62-6. [PMID: 15743575 DOI: 10.1157/13071607] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Nocardiosis is difficult to diagnose and infrequently associated with bronchiectasis or cystic fibrosis. This study analyzes the clinical and microbiological characteristics of 40 patients in whom microorganisms belonging to the Nocardia asteroides complex were isolated. METHODS We studied 27 males and 13 females, with a mean age of 45 years (8-82). Nocardia spp. were isolated in 129 samples. Cultures were performed with conventional methods; additionally, when branching Gram-positive bacilli were visualized on microscopic examination, modified BCYE-alpha (m) medium was used. RESULTS In 77.5% of the cases, investigation for Nocardia spp. was based on microscopy findings, in six patients it was a fortuitous finding in BCYE-alpha (m) medium, and in only three patients nocardiosis was clinically suspected. Twenty-five patients had nocardiosis (5 disseminated infection and 20 lung infection) and the remaining 15 were colonized. The most frequent risk factor in the infections, whether disseminated or not, was systemic glucocorticoid use (P 5 .001). The most frequent underlying pathology was bronchiectasis (80%), associated or not with cystic fibrosis. There were seven deaths and two patients had neurological sequelae. CONCLUSIONS Bronchiectasis was an important risk factor for colonization by Nocardia spp. (P 5 0.01) in all the patients studied, and for infection (P 5 0.05) in patients without cystic fibrosis. The use of BCYE-alpha (m) medium in processing respiratory secretions highly facilitated the isolation of Nocardia spp.
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Affiliation(s)
- Adelaida Ferrer
- Servicio de Microbiología, Hospital Universitario Vall d'Hebron, Po. Vall d'Hebron 119-129, 08035 Barcelona, Spain.
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