Clinical significance, antimicrobial susceptibility and molecular identification of Nocardia species isolated from children with cystic fibrosis

ABSTRACT Nocardia is an opportunistic pathogen that causes respiratory infections in immunocompromised patients. The aim of this study was to analyze the epidemiology, clinical significance and antimicrobial susceptibility of Nocardia species isolated from eight children with cystic fibrosis. The isolated species were identified as Nocardia farcinica, Nocardia transvalensis, Nocardia pneumoniae, Nocardia veterana and Nocardia wallacei. N. farcinica was isolated in three patients and all of them presented lung affectation with a chronic colonization and pneumonia. N. farcinica showed resistance against gentamicin, tobramycin, cefotaxime, but was susceptible to trimethoprim-sulfamethoxazole and amikacin. N. transvalensis, which was isolated from two patients, showed an association with chronic colonization. N. transvalensis was resistant to tobramycin and amikacin, but susceptible to ciprofloxacin, trimethoprim-sulfamethoxazole and cefotaxime. N. veterana, N. pneumoniae and N. wallacei were isolated from three different patients and appeared in transitory lung colonization. N. veterana and N. pneumoniae were susceptible to imipenem, trimethoprim-sulfamethoxazole, amikacin, tobramycin, and cefotaxime. N. wallacei was resistant to amikacin, tobramycin, imipenem, and trimethoprim-sulfamethoxazole and susceptible to ciprofloxacin and cefotaxime. All the isolates were identified up to species level by 16S rRNA gene sequencing. The presence of Nocardia in the sputum of patients with cystic fibrosis is not always an indication of an active infection; therefore, the need for a treatment should be evaluated on an individual basis. The detection of multidrug-resistant species needs molecular identification and susceptibility testing, and should be performed for all Nocardia infections.

Long-term treatment of persistent disseminated Nocardia cyriacigeorgica infection

In this paper a disseminated persistent Nocardia cyriacigeorgica infection in an immunocompetent patient is described. The patient's long-term treatment, as well as its implications for managing similar cases in the future, is emphasized. Presenting with high fever, multiple nodules, and ulcerative cutaneous lesions of body sites, the patient was treated with various antimicrobials. Under combined therapy, empyema and arthritis, leading to disseminated nocardiosis, were seen. The overall treatment course was 28 months. It can be concluded that the choice of the antibiotics and optimal duration of treatment are uncertain; therefore the treatment of nocardiosis requires expertise.

Nocardiosis: an overview and additional report of 28 cases in cattle and dogs / Nocardiose: visão geral e relato de 28 casos em vacas e cães

Phenotypic characteristics, antimicrobial susceptibility profile, and clinical-epidemiological features of 28 Nocardia strains isolated from 19 cases of bovine mastitis, eight cutaneous-subcutaneous lesions and one case of pneumonia in dogs were evaluated. Microbiological, biochemical, cytological and scanning electron microscopy methods were used in diagnosis. Nocardia asteroides type IV, Nocardia otitidiscaviarum,Nocardia nova (type III) and Nocardia farcinica (type V) were isolated from bovine milk, bronchial lavage and/or cutaneous-subcutaneous abscesses in dogs. Nocardial bovine mastitis was diagnosed predominantly in clinical cases, in dairy herds with poor environmental hygienic conditions between milking and inappropriate intramammary therapy. Canine nocardiosis was observed commonly in animals co-infected with distemper virus. Sulphamethoxazole-trimethoprim (92.8 percent), amikacin (92.8 percent) and ceftiofur (92.8 percent) were the most effective drugs in 28 isolates. Multiple drug resistance to three or more and five or more antimicrobials was observed in ten (35.7 percent) and three (10.7 percent) strains, respectively, predominantly with use of cloxaxillin, cefoperazone and ampicillin. The species (type) classification, clinical-epidemiological characteristics, diagnosis, multiple-drug resistance and public health considerations in Nocardia strains isolated from cattle and dogs in Brazil are discussed, with special reference to report of bovine mastitis by N. otitidiscaviarum by first time in Brazil and the similarity between Nocardia species isolated from human and animal origin.

A caracterização fenotípica, perfil de sensibilidade aos antimicrobianos e aspectos clínico-epidemiológicos foram avaliados em 28 linhagens de Nocardia isoladas de 19 casos de mastite, oito lesões tegumentares e um caso de pneumonia em cão. Foram utilizados no diagnóstico métodos microbiológicos, bioquímicos, citológicos e microscopia eletrônica de varredura. Nocardia asteroides tipo IV, N. otitidiscaviarum,N. nova (tipo III) e N. farcinica (tipo V) foram isoladas do leite de vacas com mastite, de material de lavado transtraqueal e de lesões cutâneas de cães. Nocardiose mamária bovina foi diagnosticada predominantemente sob a forma clínica, em propriedades com precárias condições de higiene na pré e pós-ordenha, e inadequado procedimento de terapia intramamária. Nocardiose canina foi diagnosticada comumente em animais co-infectados com o vírus da cinomose. Sulfametoxazole/trimetoprim (92,8 por cento), amicacina (92,8 por cento) e ceftiofur (92,8 por cento) foram os antimicrobianos mais efetivos frente às linhagens de Nocardia. Resistência múltipla a três ou mais e cinco ou mais antimicrobianos foram observadas, respectivamente, em dez (35,7 por cento) e três (10,7 por cento) linhagens, notadamente frente à cloxacilina, cefoperazona e ampicilina. A caracterização de espécies (tipo), aspectos clínico-epidemiológicos, diagnóstico, resistência múltipla aos antimicrobianos e reflexos em saúde pública de linhagens de Nocardia isoladas de bovinos e cães no Brasil foram discutidos. Foi destacada a similaridade entre as espécies de Nocardia isoladas de animais e do homem, e a primeira descrição no Brasil de N. otitidiscaviarum na etiologia da mastite bovina.

Constitutive acetonitrile hydrolysing activity of Nocardia globerula NHB-2: Optimization of production and reaction conditions.

Nocardia globerula NHB-2 exhibited an intracellular acetonitrile hydrolysing activity (AHA) when cultivated in nutrient broth supplemented with glucose (10.0 g/l) and yeast extract (1.0 g/l), at pH 8.0, 30 degrees C for 21 hr. Maximum AHA was recorded in the culture containing 0.1 M of sodium phosphate buffer, (pH 8.8) at 45 degrees C for 15 min with 600 micromol of acetonitrile and resting cells of N. globerula NHB-2 equivalent to 1.0 ml culture broth. This activity was stable up to 40 degrees C and was completely inactivated at or above 60 degrees C. About five-fold increase in AHA was observed after optimization of culture and reaction conditions. Under the optimized conditions, this organism hydrolyzed various nitriles and amides such as propionitrile, benzonitrile. acetamide, and acrylamide to corresponding acids. This nitrile/amide hydrolysing activity of N. globerula NHB-2 has potential applications in enzymatic synthesis of organic acids and bioremediation of nitriles and amides contaminated soil and water system.

Isolated nocardiasis presenting as a huge cold abscess: a case report and review of literature

Nocardia, a gram positive higher bacterium, presents usually as pulmonary disease or mycetoma, or rarely as metastatic lesion from lung, or as a primary isolated lesion in skin, subcutaneous tissues, lymphatics, eyes, central nervous system. etc. We report a case, a 50 years old male diabetic, who presented with a rare manifestation of Nocardiasis in the form of an isolated gluteal abscess involving subcutaneous tissue and intermuscular planes that was drained successfully and diagnosis confirmed on culture of pus. Isolated nocardial lesions, a rarity, are seen in immunocompromised host. Our patient, the first of its kind reported from Al Dhahira region of Oman, had only diabetes mellitus [DM] as associated illness and did not have any identifiable source of infection. Diabetes may have caused some compromise in immunity; otherwise he did not have HIV infection or any other cause for depressed immunity. Nocardiasis should be suspected in immunocompromised patients with peculiar mass lesion, strange neurologic presentation and isolated lesions such as gluteal abscess, as in our patient

Nocardiosis pulmonar en dos mujeres con enfermedad HIV/SIDA / Pulmonary nocardiosis in two women with HIV/SIDA

La nocardiosis es una enfermedad producida por un actinomiceto aerobio de la familia Nocardiaceae. Habita en suelos y, usualmente, penetra a través del tracto respiratorio de pacientes inmunocomprometidos. Los varones son afectados con frecuencia que las mujeres. Presentamos los dos primeros casos de pacientes de sexo femenino con infección HIV/SIDA/nocardiosis, diagnosticados en nuestro hospital. Ambas pacientes tenían un severo compromiso inmunológico, con cargas virales superiores a las 10.000 copias/ml, y en las dos, la forma de presentación fue pulmonar. El diagnóstico de nocardiosis se realizó en las dos enfermas a partir del examen directo y cultivos de esputo. Una de las pacientes recibió cotrimoxazol+amikacina y la otra fue tratada con cefalosporinas. Ambas tuvieron una evolución satisfactoria de sus lesiones pulmonares. Se concluye afirmando que debe incluirse a la nocardiosis en el diagnóstico diferencial de las neumonías extrahospitalarias en pacientes HIV positivos, en especial en aquellas neumopatías de curso subagudo o crónico

Antibiotic sensitivity patterns of actinomycetes isolated from patients of actinomycetoma.

The effectiveness of eight antibiotics against 30 human isolates of actinomycetoma agents belonging to 7 different species were tested by agar dilution and disc diffusion methods to evaluate the susceptibility patterns and to study drug resistance among the organisms. It was found that many of the isolates had developed partial or complete resistance to conventionally used antibiotics like cotrimoxazole, streptomycin and ampicillin, but almost all were sensitive to amikacin and ciprofloxacin. The two methods were equally effective for detecting sensitivity patterns of the Nocardia isolates.

Micetoma por nocardia: presentación de un caso / Nocardia mycetoma: report of one case

Una mujer de 32 años desarrolló una lesión con inflamación local, nódulos linfáticos agrandados en cadena que ascendían proximalmente, seguido de una picadura de una hormiga gigante. Seguidamente desarrollo vesículas que segregaban material purulento. Clínicamente de sospechó infección micótica por esporotricosis. Se realizó biopsia y cultivo y se aisló un bacilo Gram (+) y filamentoso, que después de la clasificación por cultivo reveló ser nocardia brasiliensis, produciendo una lesión linfocutánea localizada (micetoma).