Nocardia Asteroides Research Articles

Posttraumatic exogenous nocardia endophthalmitis

Purpose To report a case of posttraumatic exogenous Nocardia endophthalmitis. Design Interventional case report. Methods A 46-year-old man presented with counting fingers vision, severe eye pain, hypopyon, and an iris mass consistent with endophthalmitis following a penetrating injury to the left eye. Results Despite oral fluconazole and repeated intravitreal injections of vancomycin, gentamicin, and amphotericin B, the eye remained painful with a persistent hypopyon and recurrent iris masses. Cultures of the vitreous and iris masses remained negative for organisms. Despite vitrectomy and sector iridectomy of the iris mass with repeat injections of intravitreal antibiotics, the patient continued to have severe pain, poor vision, and developed new iris masses. Enucleation cultures confirmed Nocardia asteroides. Conclusions Posttraumatic exogenous Nocardia endophthalmitis is extremely rare, and its clinical signs can mimic a fungal infection.

Concomitant Spine Infection With Mycobacterium Tuberculosis and Pyogenic Bacteria

A case report of an extremely rare condition describing lumbar spine tuberculosis associated with concurrent pyogenic infection is presented. To establish that isolation of pyogenic bacteria from an infected spine does not exclude the possibility of spine tuberculosis. During a MEDLINE data search from January 1960 through October 2001, no cases of combined spine tuberculosis and pyogenic infection were found. A 52-year-old man reported left-side gluteal swelling, backache, and fever of 20 days duration. A similar swelling in the same location had occurred 12 years previously, and an operation was performed at that time. Preoperative syringe-aspirated material from a gluteal abscess was sent for ordinary bacteriologic culture (for only aerobic pyogenic bacteria). During the operation, a needle-aspirated specimen of evacuated pus was subjected to direct microscopy and culture. Direct Gram stain for pyogenic bacteria and direct Ziehl-Neelsen stain for mycobacteria were performed. Cultures for aerobes, anaerobes, mycobacteria, and fungi were made. The preoperative specimen culture showed growth of Nocardia asteroids and Moraxella catarrhalis, whereas the operative specimen showed Gram-positive cocci and acid-fast bacilli on direct smears. The operative cultures yielded growth of Nocardia asteroids, Moraxella catarrhalis, and Mycobacterium tuberculosis. Plain lumbar spine radiograph showed psoas muscle calcification. It is concluded from this case that recovery of pyogenic bacteria from an infected spine does not exclude spine tuberculosis. It is recommended, therefore, that mycobacterial investigations be performed for cases that have evidence of tuberculosis, even when pyogenic microorganisms already have been isolated. The clues that raise suspicion of tuberculosis in patients with pyogenic spine infection include chronic infection that does not respond to ordinary antibiotics, isolated pyogenic bacteria of low virulence, psoas muscle calcification, and immunosuppression.

Nocardial infections in Japan from 1992 to 2001, including the first report of infection by Nocardia transvalensis.

In the period from 1992 to 2001, 303 cases of nocardioses were diagnosed in Japan, with the corresponding etiological agents isolated and characterized. Taxonomic analyses of these 303 strains showed that most nocardial infections were caused by members of the Nocardia asteroides group (72.3%). Speciation showed that 72 strains were N. asteroides, 31 strains were N. cyriacigeorgica, 2 strains were N. beijingensis, 81 strains were N. farcinica, and 33 strains were N. nova. Sixty-six strains of N. brasiliensis were the next most prevalent species of the total Nocardia isolates, followed by 14 strains of N. otitidiscaviarum. Infections by N. transvalensis (3 strains) and N. pseudobrasiliensis (1 strain) were also confirmed. The infections due to N. transvalensis, N. cyriacigeorgica, and N. beijingensis were the first reported in Japan. The most common factor that predisposed individuals to nocardial infection in Japan was therapy by immunosuppressive agents (22.4%), including SLE therapy (3.6%), followed by cancer (6.6%), diabetes (3.6%) and AIDS (2.0%). Nocardial infections occurred more commonly in the elderly, with most of the patients between the ages of 61 and 80 years of age. No significant difference regarding infectivity levels between the sexes was observed.

Disseminated Nocardia asteroides Infection in an Immunocompetent Woman Following an Arm Injury

A case of disseminated infection with Nocardia asteroides in a 55-year-old immunocompetent woman after mild trauma to the arm is reported. Secondary dissemination was identified in the skin, right kidney, liver, peritoneal cavity, lungs and thigh. The patient was successfully treated with surgical drainage and a 9-week course of antibiotics including cefotaxime, amikacin, chloramphenicol, trimethoprim/sulfamethoxazole (TMP/SMX) and doxycycline. The administration of TMP/SMX in combination with doxycycline was clinically beneficial despite in vitro resistance.

Phylogeny of the genus Nocardia based on reassessed 16S rRNA gene sequences reveals underspeciation and division of strains classified as Nocardia asteroides into three established species and two unnamed taxons.

Conventional identification of Nocardia in the routine laboratory remains problematic due to a paucity of reliable phenotypic tests and due to the yet-unresolved taxonomy of strains classified as belonging to the species Nocardia asteroides, which comprises the type strain and isolates with drug pattern types II and VI. The 16S rRNA gene of 74 representative strains of the genus Nocardia, encompassing 25 established species, was sequenced in order to provide a molecular basis for accurate species identification and with the aim of reassessing the phylogeny of taxons assigned to the species N. asteroides. The result of this phylogenetic analysis confirms that the interspecies heterogeneity of closely related nocardial species can be considerably low (a sequence divergence of only 0.5% was found between N. paucivorans and N. brevicatena). We observed a sequence microheterogeneity (sequence divergence of fewer than five bases) in 8 of 11 species of which more than one strain in the species was studied. At least 10 taxons were found that merit description as new species. Strains previously classified as N. asteroides fell into five distinct phylogenetic groups: the type strain cluster (N. asteroides sensu strictu), N. abscessus, N. cyriacigeorgica, and two clusters closely related to N. carnea or N. flavorosea. The strains within the latter two groups probably represent new species, pending further genetic and phenotypic evaluation. Restricted phenotypic data revealed that N. abscessus, N. cyriacigeorgica, and the two Nocardia species taxons are equivalent to drug patterns I, VI, and II, respectively. In the future, these data will help in finding species-specific markers after adoption of a more precise nomenclature for isolates closely related to N. asteroides and unravel confusing phenotypic data obtained in the past for unresolved groups of strains that definitely belong to separate taxons from a phylogenetic point of view.

Systemic Nocardiosis in a Splenectomized Patient with Systemic Lupus Erythematosus

A splenectomized patient with systemic lupus erythematosus, who had previously been treated with high doses of corticosteroids, presented with headaches and symptoms of a respiratory tract infection. A magnetic resonance imaging scan of the brain revealed a ring-enhancing lesion, and Nocardia asteroides was isolated from a stereotactic biopsy specimen. After adverse reactions to a number of antibiotics, infection control was finally achieved by the new oxazolidinone drug, linezolid. Nocardiosis should be considered as a differential diagnosis in all immunocompromised patients who develop an obscure infection; delay in diagnosis and subsequent initiation of appropriate treatment often results in a fatal outcome. Linezolid is a new option for the treatment of nocardiosis and is effective when given orally.

Efficacy of amikacin combinations for nocardiosis.

We isolated five bacterial strains from patients diagnosed as having nocardiosis. Bacterial species were identified based on the similarities in the nucleotide sequences of 16S ribosomal RNAs. Three of the five strains were identified as Nocardia asteroids, but unexpectedly other two were Streptomyces hygroscopicus and Rothia dentocariosa. The latter two species are not members of the family Nocardiaceae. We investigated the susceptibilities of these five strains to the following nine antimicrobial agents: trimethoprim/sulfamethoxazole (TMP/SMX), minocycline (MINO), erythromycin (EM), amikacin (AMK), cefotaxime (CTX), faropenem (FRPM), imipenem (IPM), ciprofloxacin (CPFX), and sparfloxacin (SPFX). The minimum inhibitory concentration (MIC) ranges (mg/ml) were as follows: TMP-SMX, 4- > 32; MINO, 0.125-8; EM, < or = 0.016- > 32; AMK, 1-2; CTX, 0.063- > 32; FRPM, 0.063-16; IPM, 0.125-2; CPFX, 4-32; and SPFX, 0.5-16. Moreover, the synergistic effects of AMK in combination with each of TMP-SMX, MINO, EM, CTX, IPM, and SPFX were investigated by checkerboard synergy testing. No antagonism was recognized for the three N. asteroides strains. Synergistic and additive effects were observed for the combinations of AMK with CTX, IPM, or SPFX.

Esclerite infecciosa espontânea por Nocardia asteroides: relato de caso

PURPOSE: To report a case of Nocardia asteroides scleritis in a patient without risk factors for infeccious scleritis. METHODS: A 38-year old woman was initially examined for pain, discharge, photophobia of 1 month duration in her right eye. Her medical and ophthalmological history were unremarkable. The results of laboratory tests were normal. Surgical debridement of necrotic tissue was performed and material was sent for biopsy and culture confirmed as Nocardia asteroides. Treatment consisted of amikacin eyedrops, and systemic trimethropim-sulfamethoxazole. The infection resolved leaving scleral thinning and a subconjunctival fibrovascular scar. Best corrected visual acuity two months after referral had improved to LE, 20/20. CONCLUSION: Prompt evaluation and treatment is essential for successful management of Nocardia asteroides infectious scleritis.

Nocardial cerebral abscess: Report of three cases and review of the current neurosurgical management

Nocardia asteroides cerebral abscesses are rare but challenging intracranial lesions. Early diagnosis, institution of appropriate antimicrobial therapy, lack of underlying systemic disease and limited intracranial disease are recognized factors leading to good outcome. However, the optimal treatment approach has not been established and nocardial brain abscesses have been managed either conservatively, with stereotactic aspirations or with open craniotomy and enucleation. We present three cases of Nocardia asteroides cerebral abscesses cured only after neurosurgical enucleation, and discuss the current management alternatives and conclude that a more aggressive approach than that currently preferred for this entity may be more effective.

INIMUNOPATHOLOGIC RELATION BETWEEN Nocardia asteroides AND Brucella abortus t GAINED EXPERIMIENTALLY

In order to demonstrated the pathologic changes and immune response of Brucella aboruls strain 19. Vaccinated guinea pigs were experimentally infected With Nocardia asteroides, 24 guinea pigs of both six were divided into four equal groups. The first group was inoculated sub-cutaneously with Brucella abortus strain 19 vaccine. The second group was inoculated inuapulmonary with 1 X 103 C.F.U of viable Nocardia asteroides. Thirty days post-inoculation the first, second and third groups were challenged intrapulmonary with 2.5 K 109 C.F.U. of Nocardia asteroides, the last group served as control. The results showed that mortality was 100 % in non~ vaccinated -animals, 33.4 % in immunized animals with Nocardia asteroides and zero in Brucella abortus vaccinated animals.

Infection with Nocardia species: clinical spectrum of disease and species distribution in Madrid, Spain, 1978-2001.

Clinical experience with nocardiosis is very limited in European countries. We describe 34 cases of nocardial infection seen at one Spanish teaching hospital. A retrospective review of the clinical features and outcome of nocardial infections was conducted during a 24-year period (1978-2001). All cases were confirmed by culture. Predisposing factors included immunosuppression and/or pulmonary disease in 85% of patients; eight cases were related to HIV infection. Most isolates were initially identified as Nocardia asteroides complex (97%). The most common clinical form was pulmonary disease (41%), followed by disseminated (15%), cutaneous (12%), cerebral (9%) and articular disease (3%). A high proportion of patients (20%) had pulmonary colonization. Therapy with sulfonamides, imipenem or amikacin was given to 26 patients and a clinical response was observed in 65%. Overall mortality among patients with nocardial disease was 48% (13/27) but only seven patients (26%) died from nocardiosis. Nocardiosis remains a rare opportunistic infection that appears in immunosuppressed patients. HIV infection has become a common predisposing condition. The species distribution and disease spectrum are similar to those described in other European countries. Although most patients develop active disease, pulmonary colonization might not be as rare as has generally been assumed. Treatment with sulfonamides is usually effective and many patients may remain free of nocardial disease for a prolonged period.

The role of intramammary pathogens in dairy goats

Pathogens involved in goats mastitis and the strategies for their prevention and control are revised. Staphylococcus aureus is an important clinical pathogen but coagulase negative staphylococci (CNS) are the most prevalent in subclinical mastitis (more than 50% in most of the studies). Incorrect milking machine routines are usually involved in high prevalence of CNS. Contagious agalactia (CA) is an important disease affecting goats and antibiotic treatment and vaccination are controversial. Streptococci and Gram negative bacilli (GNB) are major intramammary pathogens but not very frequent in goats and are associated with poor hygienic conditions in housing and the milking parlour. Because of the lower prevalence of GNB mastitis in goats than cows, physiological and environmental factors protecting goats from GNB infection are discussed. Other pathogens affecting the caprine mammary gland are also discussed, such as Arcanobacterium pyogenes, Bacillus spp., Clostridium perfringens, Nocardia asteroides and lentiviruses (caprine arthritis-encephalitis virus).

Neuroinvasive Nocardia asteroides GUH-2 Induces Apoptosis in the Substantia Nigra in Vivo and Dopaminergic Cells in Vitro

Neurodegenerative diseases such as Parkinson's disease are increasingly prevalent in the aging population worldwide. The causes of these disorders are unknown, but many studies have suggested that the etiology is likely multifactorial and may involve exposure to something in the environment combined with the normal aging process. Nocardia asteroides are bacteria commonly found in the soil, and neuroinvasive strains of nocardiae have been described. N. asteroides strain GUH-2 invades the brains of experimentally infected animals and selectively affects dopaminergic neurons of the substantia nigra (SN), causing an l-DOPA-responsive movement disorder resembling parkinsonism. Furthermore, dopaminergic neurons undergo morphological changes characteristic of apoptosis following nocardial infection. Apoptosis has been implicated in dopaminergic neuronal dropout in Parkinson's patients as well as other parkinsonian models. Thus, in this study, in vivo and in vitro models were utilized to measure the ability of GUH-2 to induce the apoptotic death of dopaminergic cells. Following infection with GUH-2, dopaminergic apoptotic cells were identified in the SN of animals by in situ end labeling, which detects DNA fragmentation, combined with fluorescent immunolabeling of tyrosine hydroxylase-positive cells. In addition, apoptosis was observed in PC12 cell cultures incubated with GUH-2 by both in situ end labeling and the annexin V assay, which detects externalization of phosphatidylserine of the plasma membrane, indicating apoptotic death. Based on the results of these studies, it appears that experimental infection with N. asteroides provides a general model for studying apoptosis in parkinsonian disorders.

Murine polymorphonuclear neutrophils produce interferon-γ in response to pulmonary infection withNocardia asteroides

Nocardia asteroides causes an acute, necrotizing pneumonia characterized by extensive infiltration of polymorphonuclear neutrophils (PMNs) into the lungs. Although PMNs have historically been classified as end-point cells, recent investigations have indicated that PMNs have the ability to secrete cytokines such as interleukin (IL)-4 and IL-12. This study investigated the ability of PMNs to produce cytokines in a murine model of N. asteroides pulmonary infection. Flow cytometric analysis demonstrated the production of interferon-gamma (IFN-gamma), but not IL-4, by PMNs in response to this infection. IFN-gamma production correlated with peak infiltration of PMNs into the lungs. Cell sorting and enzyme-linked immunosorbent assay were used to confirm cytokine production by cells with nuclear morphology characteristic of PMNs. This is the first report of IFN-gamma production by neutrophils in response to an infection in vivo. These results suggest that PMNs play an important role in directing the host toward a T helper cell type 1 phenotypic response in the lungs.

활성슬러지 혼합미생물과 Nocardia asteroides에 의한 페놀화합물 분해시 양성자이온의 영향

This study was investigated to evaluate the effect of the sodium ion and pH on toxicity of dinitrophenol at high concentrations (0.41 to 0.54 mM), over a sodium concentration range of 0.1 mM to 107 mM and over a pH range of 5 to 9. The concentration of sodium ions in the activated sludge mixed liquor seemed to have very little effect on dinitrophenol toxicity. However, lack of sodium in the growth media resulted in a reduction of the dinitrophenol degradation rate by bacterial isolate from the activated sludge culture, which has been identified as Nocardia asteroides. Dinitrophenol inhibition was found to be strongly dependent on mixed liquor pH. The dinitrophenol degradation rate was highest in the pH range of 6.95 to 7.84; at pH 5.94 degradation of 75 mg/L dinitrophenol was significantly inhibited; at pH < 5.77, dinitrophenol degradation was completely inhibited after approximately 30% of the dinitrophenol was degraded.

Inherited Interleukin-12 Deficiency: IL12B Genotype and Clinical Phenotype of 13 Patients from Six Kindreds

Interleukin-12 (IL12) is a cytokine that is secreted by activated phagocytes and dendritic cells and that induces interferon-gamma production by natural-killer and T lymphocytes. It consists of two subunits, p35 and p40, which are encoded by IL12A and IL12B, respectively. The first reported patient with a genetic cytokine disorder was a Pakistani child, who was homozygous for a large loss-of-function deletion (g.482+82_856-854del) in IL12B. This IL12-deficient child suffered from infections caused by bacille Calmette-Guérin (BCG) and Salmonella enteritidis. We herein report 12 additional patients from five other kindreds. In one kindred from India, the same large deletion that was described elsewhere (g.482+82_856-854del) was identified. In four kindreds from Saudi Arabia, a recessive loss-of-function frameshift insertion (g.315_316insA) was found. A conserved haplotype encompassing the IL12B gene suggested that a founder effect accounted for the recurrence of each mutation. The two founder mutational events-g.482+82_856-854del and g.315_316insA-were estimated to have occurred approximately 700 and approximately 1,100 years ago, respectively. Among a total of 13 patients with IL12 deficiency, 1 child had salmonellosis only and 12 suffered from clinical disease due to BCG or environmental nontuberculous mycobacteria. One patient also had clinical disease caused by virulent Mycobacterium tuberculosis, five patients had clinical disease caused by Salmonella serotypes, and one patient had clinical disease caused by Nocardia asteroides. The clinical outcome varies from case to case, since five patients (aged 2-11 years) died of overwhelming infection, whereas eight patients (aged 3-12 years) are still in good health and are not currently taking antibiotics. In conclusion, IL12 deficiency is not limited to a single kindred, shows significant variability of outcome, and should be considered in the genetic diagnosis of patients with mycobacteriosis and/or salmonellosis. To date, two founder IL12B mutations have been identified, accounting for the recurrence of a large deletion and a small insertion within populations from the Indian subcontinent and from the Arabian Peninsula, respectively.

Primary cutaneous nocardiosis with multiple, subcutaneous abscesses in a patient with sarcoidosis

A case of multiple subcutaneous nocardial abscesses is reported in a pateint who received systemic corticosteroids over a period of about 4 years for the treatment of visceral sarcoidosis. The diagnosis of subcutaneous sbscess caused by Nocardia asteroides was made based on bacteriological examination. It could not be determined before treatment whether the abscesses represented primary or secondary nocardiosis. Surgical drainage and systemic administration of minocycline hydrochloride dramatically resolved the cutaneous lesions. To the authors' knowledge, this is the first reported case in Japan of primary cutaneous nocardiosis in a patient with sarcoidosis.

What is the evidence for a relationship between Chlamydia pneumoniae and late-onset Alzheimer’s disease?

Beginning with the demonstration of Helicobacter pylori as an etiologic agent for ulcers, the notion that microbial pathogens can play an initiating and/or exacerbatory role in chronic disease has gained increasing credence. Indeed, studies have suggested associations between Chlamydia trachomatis and cervical cancer,1 Nocardia asteroides and Parkinson’s disease,2 and Chlamydia pneumoniae and atherosclerosis,3 among many others [T1]. While most such associations are controversial, these lines of research remain under active investigation. In this article, evidence for and against the association between late-onset Alzheimer’s disease (AD) and persistent infection with C. pneumoniae will be reviewed. AD is a progressive neurodegenerative disease associated with atrophy/ death of neurons in affected brain regions. The disease occurs in two forms: an early-onset form which is primarily genetically determined, and a far more common late-onset form which is not genetically determined. Incidence of the latter increases with increasing age, and AD is considered to be the most significant single cause of senile dementia.4 The disease usually manifests itself in its early stages by minor loss of PCR assays from two groups indicated that C. pneumoniae DNA is present in a high proportion of brain tissue samples from late-onset Alzheimer’s disease (AD) patients but not in those from non-AD controls. Immunohistochemical analyses from two laboratories support this observation, and electron and immunoelectron microscopy have been used to visualize chlamydial organisms in the AD brain; however, some laboratories have been unable to repeat the PCR and immunohistochemical results. Other experimental data support a relationship between the pathobiology of C. pneumoniae and possession of the APOE e4 allele type, which is a known risk factor for late-onset AD. Selected Examples of Possible Associations Between Bacteria and Chronic Diseases

Increase of gammadelta T lymphocytes in murine lungs occurs during recovery from pulmonary infection by Nocardia asteroides.

Previous studies have demonstrated that gammadelta T lymphocytes are important for host resistance to pulmonary infection of the murine lung by log-phase cells of Nocardia asteroides. To study the role of gammadelta T cells in nocardial interactions in the murine lung, C57BL/6J wild type and C57BL/6J-Tcrd (gammadelta T-cell knockout mice) were infected intranasally with log-phase cells of N. asteroides GUH-2. At 3, 5, and 7 days after infection, the gammadelta T cells were quantified by multiparameter flow cytometry. At the same time, Gram and hematoxylin-eosin stains of paraffin sections were performed to monitor the host responses. The data showed that gammadelta T lymphocytes increased significantly within the lungs after intranasal infection, and the peak of this cellular increase occurred at 5 days. Furthermore, at this time, greater than 50% of the CD3 T-cell receptor (TCR)-positive (CD3+) cells were gammadelta TCR positive. Histological examination clearly showed divergent inflammatory responses in the lungs of wild-type mice compared to gammadelta T-cell knockout mice. The C57BL/6J-Tcrd mice were less capable of clearing the organism, and the polymorphonuclear leukocyte response lasted longer than in wild-type C57BL/6J mice. These results showed that gammadelta T cells were actively involved in modulating the innate host responses to murine pulmonary infection by N. asteroides.

Mycobacterial and nonbacterial pulmonary complications in hospitalized patients with human immunodeficiency virus infection: a prospective, cohort study.

BackgroundA prospective observational study was done to describe nonbacterial pulmonary complications in hospitalized patients with human immunodeficiency virus (HIV) infection.MethodsThe study included 1,225 consecutive hospital admissions of 599 HIV-infected patients treated from April 1995 through March 1998. Data included demographics, risk factors for HIV infection, Acute Physiology and Chronic Health Evaluation (APACHE) II score, pulmonary complications, CD4+ lymphocyte count, hospital stay and case-fatality rate.ResultsPatient age (mean ± SD) was 38.2 ± 8.9 years, 62% were men, and 84% were African American. The median APACHE II score was 14, and median CD4+ lymphocyte count was 60/μL. Pulmonary complications were Pneumocystis carinii pneumonia (85) in 78 patients, Mycobacterium avium complex (51) in 38, Mycobacterium tuberculosis (40) in 35, Mycobacterium gordonae (11) in 11, Mycobacterium kansasii (10) in 9, Cytomegalovirus (10) in 10, Nocardia asteroides (3) in 3, fungus ball (2) in 2, respiratory syncytial virus (1), herpes simplex virus (1), Histoplasma capsulatum (1), lymphoma (3) in 3, bronchogenic carcinoma (2) in 2, and Kaposi sarcoma (1). The case-fatality rate of patients was 11% with Pneumocystis carinii pneumonia; 5%, Mycobacterium tuberculosis; 6%, Mycobacterium avium complex; and 7%, noninfectious pulmonary complications.ConclusionMost pulmonary complications in hospitalized patients with HIV are from Pneumocystis and mycobacterial infection.