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Microbiology Spectrum Apr 2022The genus Nocardia includes ubiquitous environmental saprophytes and the most frequently isolated aerobic actinomycete human pathogen responsible for localized or...
The genus Nocardia includes ubiquitous environmental saprophytes and the most frequently isolated aerobic actinomycete human pathogen responsible for localized or disseminated infection. Herein, the species distribution and antimicrobial susceptibility profiles of 441 nonrepetitive Nocardia strains are reported, collected from 21 provinces/cities in China over 13 years (from 2009 to 2021). These isolates were identified to species level by mass spectrometry or targeted DNA sequencing. The susceptibility profiles of Nocardia species for 15 antibiotics were determined by the broth microdilution method. Among these Nocardia isolates, Nocardia farcinica was the most commonly isolated species (39.9%, 176 of 441), followed by Nocardia cyriacigeorgica (28.6%, 126), Nocardia abscessus (6.6%, 29), and Nocardia otitidiscaviarum (5.9%, 26). Furthermore, 361 Nocardia strains (81.9%) were collected from lower respiratory tract (sputum, lung tissue, and bronchoalveolar lavage fluid), 50 (11.3%) were collected from skin and soft tissues, 9 were collected from blood, 9 were collected from eye, 4 were collected from cerebrospinal fluid and brain abscesses, and 2 were collected from pleural effusion. All of the Nocardia strains were susceptible to linezolid, followed by amikacin (99.3%) and trimethoprim-sulfamethoxazole (TMP-SMX) (99.1%). The antibiotic resistance profiles of other antibiotics varied tremendously among different Nocardia species. This demonstrated that accurate species identification and/or antibiotic susceptibility testing should be performed before the usage of these antibiotics. In summary, this is the largest study on the species and antibiotic resistance profiles of the genus Nocardia circulating in China, and our data will contribute to a better understanding of clinical nocardiosis. The genus Nocardia has the potential to cause nocardiosis, which might be underrecognized and underdiagnosed. Herein, the demographical features of 441 nonrepetitive nocardiosis cases and species distribution of their Nocardia strains in China, 2009 to 2021, are summarized. The susceptibility profiles for 15 antibiotics against all of the above Nocardia strains were also determined by the broth microdilution method. To date, this is the largest study on the genus Nocardia contributing to nocardiosis in China. Our study will be helpful for understanding the species diversity of Nocardia isolates distributed in China and for decision-making in the context of nocardiosis diagnosis and treatment.
Topics: Anti-Bacterial Agents; Base Sequence; Drug Resistance, Bacterial; Humans; Nocardia; Nocardia Infections
PubMed: 35234511
DOI: 10.1128/spectrum.01560-21 -
Emerging Infectious Diseases Jun 2023Nocardia can cause systemic infections with varying manifestations. Resistance patterns vary by species. We describe N. otitidiscavarium infection with pulmonary and...
Nocardia can cause systemic infections with varying manifestations. Resistance patterns vary by species. We describe N. otitidiscavarium infection with pulmonary and cutaneous manifestations in a man in the United States. He received multidrug treatment that included trimethoprim/sulfamethoxazole but died. Our case highlights the need to treat with combination therapy until drug susceptibilities are known.
Topics: Male; Humans; Nocardia Infections; Nocardia; Trimethoprim, Sulfamethoxazole Drug Combination; Anti-Bacterial Agents
PubMed: 37209690
DOI: 10.3201/eid2906.221854 -
Journal of Infection in Developing... Feb 2020Nocardia otitidiscaviarum is a rare cause of human infections, mostly causing cutaneous and lymphocutaneous infections of mild severity. We report two cases of fatal... (Review)
Review
INTRODUCTION
Nocardia otitidiscaviarum is a rare cause of human infections, mostly causing cutaneous and lymphocutaneous infections of mild severity. We report two cases of fatal pulmonary infection caused by Nocardia otitidiscaviarum in elderly patients.
METHODOLOGY
Case 1: A 70-year old woman presented with fever and cough with expectoration for a month. On physical examination, she had tachypnea and inspiratory crepitations in bilateral basal regions. Case 2: A 74-year old man presented with productive cough with foul smelling expectoration, fever and shortness of breath for one week. On examination, he had tachypnea, bilateral wheezing and inspiratory crepitations. In both cases, sputum was sent to microbiology laboratory. On direct microscopy Gram-positive, finely branching filaments were observed which were acid fast with 1% sulphuric acid. Chalky white opaque wrinkled colonies with musty basement type odour were seen on blood agar. Both patients were treated empirically with trimethoprim-sulfamethoxazole for Nocardia infection after notification of microscopy findings however both expired on Day 2 and Day 5 of admission, respectively. Both isolates were susceptible to amikacin, linezolid, ciprofloxacin and gentamicin. They were resistant to trimethoprim-sulfamethoxazole, ampicillin, amoxicillin-clavulanic acid, erythromycin, and imipenem. Based on biochemical identification and antimicrobial susceptibility pattern, the organism was identified as Nocardia otitidiscaviarum. The identification was confirmed using MALDI-TOF (Vitek MS, Biomerieux, France).
CONCLUSION
Our report highlights the importance of early identification of Nocardia to species level to improve treatment outcomes especially in critically ill patients. Mass spectrometry can become an integral part of diagnostic algorithms for nocardiosis.
Topics: Aged; Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Fatal Outcome; Female; Humans; Male; Nocardia; Nocardia Infections; Respiratory Tract Infections; Sulfamethoxazole; Trimethoprim
PubMed: 32146457
DOI: 10.3855/jidc.10169 -
Experimental and Therapeutic Medicine Nov 2016The aim of the present study was to summarize the clinical characteristics of nocardiosis caused by in order to improve the knowledge of nocardiosis. A case of...
The aim of the present study was to summarize the clinical characteristics of nocardiosis caused by in order to improve the knowledge of nocardiosis. A case of dissemination nocardiosis caused by in an immunocompetent host is reported and the associated literature reviewed. Informed consent for publication of this case report was provided by the patient. The present patient was a young immunocompetent man suffering from disseminated nocardiosis induced by infection with . Following a poor response to β-lactam antibiotic, a combination of sulfonamide with minocycline was administered, which successfully ameliorated the symptoms. Previous studies published in English were retrieved from PubMed with 'Nocardia otitidiscaviarum' used as the search keyword. A total of 23 articles were retrieved from the PubMed database, supporting the assertion that is a rare species. Among these 23 cases, there were 11 cases of lymphocutaneous (48%), 5 of pulmonary (22%), 2 of brain (9%) and 1 of pyothorax (4%) infection, and 4 cases of disseminated infections (17%). Analysis of the immune state of these patients demonstrated that 9 were immunocompetent (39%), 7 of whom had cutaneous infections (30%) with a predominant history of trauma (6/7), and 14 were immunosuppressed, 9 of whom were treated with prednisolone. Microbiology and histopathology were necessary in all cases for definite diagnosis. Among the 13 cases who underwent drug susceptibility testing, 10 cases were sensitive to trimethoprim-sulfamethoxazole (TMP-SMX) and 12 cases were sensitive to aminoglycoside. In conclusion, although is one of the less commonly isolated species of , it is capable of inducing localized or disseminated infection, even in an immunocompetent host. The majority of cases respond well to TMP-SMX and aminoglycoside, but the therapeutic action of cephalosporin is weak. Identification of bacteria and drug sensitivity tests for is critical for guiding clinical treatment.
PubMed: 27882160
DOI: 10.3892/etm.2016.3755 -
Annals of Clinical Microbiology and... May 2022Disseminated nocardiosis still causes significant morbidity and mortality and is often caused by Nocardia asteroides, N. basiliensis, and N. farcinica and are often... (Review)
Review
BACKGROUND
Disseminated nocardiosis still causes significant morbidity and mortality and is often caused by Nocardia asteroides, N. basiliensis, and N. farcinica and are often treated with trimethoprim-sulfamethoxazole (TMP-SMX). Nocardia otitidiscaviarum (N. otitidiscaviarum) rarely causes disseminated disease and resistance to TMP-SMX is even more rare.
CASE PRESENTATION
A 37-year-old woman with metastatic breast cancer and right ear deafness with recent occupational gardening and manipulating soil, presented to the hospital with first time seizure and multiple skin nodules. Magnetic resonance imaging (MRI) showed ring enhancing lesions, biopsy of the skin and brain lesions grew N. otitidiscaviarum. She was empirically treated with TMP-SMX and Imipenem-Cilastatin, however, almost three weeks into therapy, susceptibility results revealed it to be resistant to both antimicrobials, she was subsequently changed to Amikacin, Linezolid, Moxifloxacin, and Doxycycline but ultimately died.
CONCLUSIONS
This case report highlights the importance of suspecting a rare Nocardia species in patients at risk with proper occupational exposure, moreover, TMP-SMX resistance should be suspected with lack of clinical response, this may have important implications on clinical practice when facing similar infections.
Topics: Adult; Anti-Infective Agents; Female; Humans; Nocardia; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination
PubMed: 35578282
DOI: 10.1186/s12941-022-00511-9 -
Cureus Apr 2021infections typically present in immunocompromised hosts. Brain abscesses caused by species such as and are well-documented in the literature. We present a rare case...
infections typically present in immunocompromised hosts. Brain abscesses caused by species such as and are well-documented in the literature. We present a rare case of an immunocompetent patient with multiple brain abscesses due to requiring a decompressive fronto-temporoparietal craniectomy due to symptomatic intracranial hypertension. The patient was treated with intrathecal amikacin in addition to standard antibiotics with the resolution of the disease and good neurologic outcome. This is one of few case reports overall involving this species within the brain, and the second to report favorable outcomes. This case describes implications for treatment and adds to sparse literature regarding this particular pathogen.
PubMed: 33972913
DOI: 10.7759/cureus.14362 -
IDCases 2020is an aerobic, gram positive bacteria with low virulence and incidence. Despite being uncommon, has been associated with skin, lung, and disseminated infections.
BACKGROUND
is an aerobic, gram positive bacteria with low virulence and incidence. Despite being uncommon, has been associated with skin, lung, and disseminated infections.
CASE REPORT
A 56-year-old male with past medical history of type 2 diabetes mellitus and recent travel to the Bahamas presented to the emergency room with complains of abdominal pain, nausea, vomiting, and non-bloody diarrhea for four days. He ultimately required a PICC line for total parenteral nutrition. 2 days after line placement, he developed high fevers and severe right arm pain. Diagnostic imaging revealed venous thrombosis of cephalic vein and abscess formation within the soft tissue of right axilla with cultures ultimately growing . He underwent surgical incision and drainage of the abscess followed up with complete excision of the right cephalic vein and antecubital vein as well as sharp excisional debridement of skin, subcutaneous tissue and muscle fascia and was treated with trimethoprim-sulfamethoxazole for 3 months.
CONCLUSION
treatment of cutaneous disease consists of trimethoprim- sulfamethoxazole for three to six months. While guidelines for surgical intervention for cutaneous infection are not specified, our patient required surgical incision and drainage of abscess, along with excision of vein due to necrosis in addition to antibiotic treatment for 3 months with successful outcomes.
PubMed: 33163361
DOI: 10.1016/j.idcr.2020.e00986 -
Animals : An Open Access Journal From... Feb 2022We report the pathologic features of nocardiosis in five free-ranging delphinids from the Canary Islands and Andalusia, namely four striped dolphins () and one...
We report the pathologic features of nocardiosis in five free-ranging delphinids from the Canary Islands and Andalusia, namely four striped dolphins () and one bottlenose dolphin (). All animals had a multiorgan (disseminated) pattern of infection involving suppurative to pyogranulomatous and thromboembolic lesions in two or more organs. Most affected organs were (by decreasing order) lung, pulmonary lymph nodes, liver, kidney, adrenal glands, and central nervous system. Typical intralesional and intravascular branched and filamentous bacteria were highlighted by Grocott's methenamine silver and Gram stains. Bacterial analysis including 16S rRNA gene sequencing identified in two striped dolphins and in one striped dolphin and the bottlenose dolphin. All dolphins tested ( = 4) for cetacean morbillivirus were negative; one dolphin had concurrent cutaneous herpesvirosis. These results provide the first record of in cetaceans, the first account of in free-ranging dolphins, and confirmation of nocardiosis in central eastern Atlantic Ocean. These results expand the known geographic range of nocardiosis in cetaceans.
PubMed: 35203142
DOI: 10.3390/ani12040434 -
Journal of Applied Microbiology Aug 2008The metabolism of phenanthrene and anthracene by a moderate thermophilic Nocardia otitidiscaviarum strain TSH1 was examined.
AIMS
The metabolism of phenanthrene and anthracene by a moderate thermophilic Nocardia otitidiscaviarum strain TSH1 was examined.
METHODS AND RESULTS
When strain TSH1 was grown in the presence of anthracene, four metabolites were identified as 1,2-dihydroxy-1,2-dihydroanthracene, 3-(2-carboxyvinyl)naphthalene-2-carboxylic acid, 2,3-dihydroxynaphthalene and benzoic acid using gas chromatography-mass spectrometry (GC-MS), reverse phase-high performance liquid chromatography (RP-HPLC) and thin-layer chromatography (TLC). Degradation studies with phenanthrene revealed 2,2'-diphenic acid, phthalic acid, 4-hydroxyphenylacetic acid, o-hydroxyphenylacetic acid, benzoic acid, a phenanthrene dihydrodiol, 4-[1-hydroxy(2-naphthyl)]-2-oxobut-3-enoic acid and 1-hydroxy-2-naphthoic acid (1H2NA), as detectable metabolites.
CONCLUSIONS
Strain TSH1 initiates phenanthrene degradation via dioxygenation at the C-3 and C-4 or at C-9 and C-10 ring positions. Ortho-cleavage of the 9,10-diol leads to formation of 2,2'-diphenic acid. The 3,4-diol ring is cleaved to form 1H2NA which can subsequently be degraded through o-phthalic acid pathway. Benzoate does not fit in the previously published pathways from mesophiles. Anthracene metabolism seems to start with a dioxygenation at the 1 and 2 positions and ortho-cleavage of the resulting diol. The pathway proceeds probably through 2,3-dicarboxynaphthalene and 2,3-dihydroxynaphthalene. Degradation of 2,3-dihydroxynaphthalene to benzoate and transformation of the later to catechol is a possible route for the further degradation of anthracene.
SIGNIFICANCE AND IMPACT OF THE STUDY
For the first time, metabolism of phenanthrene and anthracene in a thermophilic Nocardia strain was investigated.
Topics: Anthracenes; Benzoates; Biodegradation, Environmental; Catechols; Gas Chromatography-Mass Spectrometry; Hot Temperature; Nocardia; Oxidation-Reduction; Phenanthrenes; Soil Microbiology; Soil Pollutants; Species Specificity
PubMed: 18312570
DOI: 10.1111/j.1365-2672.2008.03753.x -
Medicine Mar 2017Nocardia species are aerobic saprophytic bacilli. Among Nocardia species, Nocardia otitidiscaviarum (N otitidiscaviarum) is rarely reported in pulmonary infection. (Review)
Review
RATIONALE
Nocardia species are aerobic saprophytic bacilli. Among Nocardia species, Nocardia otitidiscaviarum (N otitidiscaviarum) is rarely reported in pulmonary infection.
PATIENT CONCERNS
We reported a case of N otitidiscaviarum pneumonia in a cotton farmer.
DIAGNOSES
N otitidiscaviarum pneumonia was identified by mass spectroscopy.
INTERVENTIONS
Combined treatments (amikacin, imipenem and trimethoprim-sulfamethoxazole) were administered after identification of N otitidiscaviarum.
OUTCOMES
The patient eventually died from severe respiratory insufficiency in the hospital.
LESSONS
Early precise diagnosis and prompt combined therapy are of vital importance in severe Nocardia pulmonary infection.
Topics: Humans; Male; Mass Spectrometry; Middle Aged; Nocardia; Nocardia Infections; Pneumonia, Bacterial
PubMed: 28353613
DOI: 10.1097/MD.0000000000006526