Nocardia Beijingensis Research Articles

Brain abscesses: the first report of disseminated Nocardia beijingensis infection in an immunocompetent individual in China

Nocardia is widely distributed in the natural environment and typically cause opportunistic infections. However, it is important to note that the pathogenicity of different Nocardia species may vary significantly. Here we reported the first case of brain abscess caused by Nocardia beijingensis (N. beijingensis) infection in China. A 70-year-old male immunocompetent individual came to our hospital for treatment due to headache. After examination, it was found that he had a brain abscess caused by N. beijingensis. By utilizing a combination of surgical intervention and antibiotic therapy, the patient ultimately achieved full recovery. In addition, we isolated this strain and displayed its ultrastructure through scanning electron microscopy. The phylogenetic tree was analyzed by 16 S rRNA sequence. A literature review of N. beijingensis infections in all immunocompetent and immunocompromised patients was presented. It highlighted that abscess formation appears to be a common manifestation of N. beijingensis infection, and N. beijingensis has become an emerging pathogen in immunocompetent individuals.

Nocardia implantans sp. nov. isolated from a patient with pulmonary infection.

TwoGram-stain-positive and rod-shaped actinomycetes (strains CDC186T and CDC192) were isolated from sputum samples of a patient in Chongqing, PR China, and were investigated to determine their taxonomic status. The results of phylogenetic analysis based on the 16S rRNA gene indicated that CDC186T and CDC192 represented members of the genus Nocardia, and the sequence similarity with Nocardia beijingensis DSM 44636T was the highest, at 99.71 and 99.78 %, respectively. The DNA G+C content of both CDC186T and CDC192 was 69.1 %. Genomic diversity analysis revealed that the average nucleotide identity and in silico DNA‒DNA hybridisation values between the two novel strains and closely related species were significantly below the thresholds of 95-96 and 70 %, respectively, but these values between the two novel strains were 99.96 and 99.90 %, respectively. The phylogenetic relationship based on the dapb1 gene and the single-copy core genes further indicated that the two novel strains were clustered in separate branch adjacent to N. beijingensis DSM 44636T. Growth occurred within the ranges of 20-42 °C, pH 6.0-9.0 and NaCl concentrations of 0.5-4.5 % (w/v). The major fatty acids of CDC186T and CDC192 were C16 : 0 and C18 : 0 10-methyl [tuberculostearic acid (TBSA)]. The predominant respiratory menaquinone was MK-9. The polar lipid profile contained diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylinositol mannoside, one unidentified glycolipid, one unidentified phospholipid and one unidentified phosphoglycolipid. All the genomes of the studied strains were annotated with virulence factor (VF)-associated genes homologous to those of Mycobacterium tuberculosis, and the results of susceptibility testing indicated that CDC186T and CDC192 were resistant to amoxicillin-clavulanic acid and tigecycline. On the basis of chemotaxonomic characteristics and the results of phylogenetic analyses, strains CDC186T and CDC192 represent a novel species within the genus Nocardia, for which the name Nocardia implantans sp. nov. is proposed. The type strain is CDC186T (=GDMCC 4.206T= JCM 34959T).

Nocardia beijingensis: An elusive diagnosis, but a favourable outcome

A 71 year old male, diabetic; had cough, low-grade fever with significant weight loss. A lesion along the mediastinal surface of the lung was seen. CT guided biopsy showed acute suppurative inflammation. Tuberculosis, Melioidosis, Mould infection, Nocardia & Actinomycosis were in the differential diagnosis and was treated with Doxycycline. However, 2 months later, abdominal discomfort with fever developed and a new necrotic lesion had developed in the right adrenal gland. Biopsy revealed Nocardia beijingensis, identified by MALDI TOF MS. Treatment with TMP SMX & Linezolid led to cure.

<i>Nocardia beijingensis</i> Brain Abscess Developing Following Intractable Pneumonia with Difficult Sulfamethoxazole-Trimethoprim Desensitization Therapy in a Previously Healthy 11-year-old Girl

<i>Nocardia beijingensis</i> Brain Abscess Developing Following Intractable Pneumonia with Difficult Sulfamethoxazole-Trimethoprim Desensitization Therapy in a Previously Healthy 11-year-old Girl

A Report of Persistent Nocardia Beijingensis Infection in a Patient with Post-Operative Abscess and Misuse of Antibiotics in China

A Report of Persistent Nocardia Beijingensis Infection in a Patient with Post-Operative Abscess and Misuse of Antibiotics in China

260. The Unfortunate Consequence of Immunosuppression in a Renal Transplant Patient

BackgroundNocardia is a slow-growing aerobic-actinomycete that belongs to the family Nocardiaceae. Major predisposing factors include corticosteroid use, organ transplantation, low CD4 count, and hematologic malignancies. The most commonly affected organs are lungs, mainly via inhalation; however, the most common extrapulmonary site is central nervous system.MethodsMatrix Assisted Laser Desorption Ionization - Time of Flight (MALDI-ToF) or 16srRNA sequencing are more reliable methodologies for accurate identification of Nocardia to the species level. To our knowledge, our patient represented the first U.S. case of N. bejingensis opportunistic disseminated infection in a renal transplant patient although similar cases have been previously reported outside the U.S.GMS stain Gram Stain of Nocardia ResultsWe present a 31-year-old Caucasian male status post renal transplant four years ago on immunosuppressants with left arm myoclonic jerks. In addition, there was an associated unilateral left frontal headache of four to five day duration. His chest CT revealed consolidative process in the right lower lobe and pleural effusion. MRI of the brain revealed multiple ring-enhancing lesions. Patient underwent left frontal craniotomy with resection and a complete evacuation of brain abscess. His brain abscess and pleural fluid cultures revealed Gram positive rods, which were subsequently identified as Nocardia beijingensis by MALDI-TOF and confirmed by 16srRNA sequencing. He was treated with intravenous imipenem & trimethoprim – sulfamethoxazole with subsequent clinical improvement.MRI Brain w/ contrast Head CT s/p left frontal craniotomy with resection & evacuation of abscess Chest CT ConclusionDifferent Nocardia species have a wide geographic distribution with varying pathogenic traits, and antimicrobial susceptibility. Hence, the identification of the specific species of Nocardia is crucial to provide a proficient level of patient care. Nocardia bejingensis is a newly discovered species of Nocardia that was first isolated in 2001 in China. Only six cases of N. beijingensis affecting CNS have been reported up to date in the United States. It is unclear of the geographic distribution and variable antimicrobial susceptibility of Nocardia bejingensis but we can confirm the first reported case of an opportunistic disseminated infection in a renal transplant patient in the United States.Agar Disclosures All Authors: No reported disclosures

Disseminated Nocardia beijingensis Infection in an Immunocompetent Patient.

To recognize Nocardia beijingensis, a slow-growing weakly acid-fast filamentous bacteria commonly causing opportunistic infections in immunocompromised hosts, as an emerging pathogen in immunocompetent patients.Tissue biopsy with Gram staining showing variable filamentous bacteria and confirmation of species using restriction enzyme analysis and 16S rRNA analysis is needed to establish a diagnosis of infection.Trimethoprim/sulfamethoxazole has been successfully used to treat infection due to Nocardia beijingensis.

A case of Disseminated Nocardia beijingensis in an Immunocompetent Patient, Manifesting as Subcutaneous and CNS Nocardiosis.

Introduction Nocardiosis is an uncommon infection, typically encountered in immunocompromised patients. With only 5 cases reported thus far in the United States, we present a case of disseminated Nocardia beijingensis in an immunocompetent patient, involving the lung, subcutaneous tissue, and CNS. Clinical Findings A 60-year-old immunocompetent male with no significant medical history presents to our institution after a complicated medical course, beginning with vague respiratory complaints. Initial work-up revealed a large right upper lung mass of unclear etiology. A month later he had a syncopal episode followed by the development of focal neurologic deficits. Main Diagnoses, Therapeutics Interventions, and Outcomes Sputum cultures obtained after the patient’s syncopal episode grew gram positive rods. CT of the chest at this time made note of a new 17 mm subcutaneous mass, which was biopsied, revealing gram positive rods with partial acid-fast staining. MRI of his brain weeks later showed multiple enhancing lesions with vasogenic edema scattered throughout. Tissue culture from his chest mass was sent off to the Mayo Clinic and ultimately grew out Nocardia beijingensis. The patient was ultimately started on the appropriate antibiotics therapy and has made significant clinical improvement. Conclusions Though Nocardia is often associated with an immunocompromised state, it is an important entity to consider in patients with pulmonary findings as well as evidence of disseminated disease, particularly CNS manifestations, regardless of immune status. A high index of suspicion is needed, as definitive diagnosis often takes weeks due to slow-growing nature of Nocardia species.

Efficient differentiation of Nocardia farcinica, Nocardia cyriacigeorgica and Nocardia beijingensis by high-resolution melting analysis using a novel locus

Accurate identification of Nocardia species remains a challenge due to the complexities of taxonomy and insufficient discriminatory power of traditional techniques. We report the development of a molecular technique that utilizes real-time PCR-based high-resolution melting (HRM) analysis for differentiation of the most common Nocardia species. Based on a novel fusA-tuf intergenic region sequence, Nocardia farcinica , Nocardia cyriacigeorgica and Nocardia beijingensis were clearly distinguished from one another by HRM analysis. The limit of detection of the HRM assay for purified Nocardia spp. DNA was at least 10 fg. No false positives were observed for specificity testing of 20 non-target clinical samples. In comparison to established matrix-assisted laser desorption/ionization-time of flight MS, the HRM assay improved the identification of N. beijingensis . Additionally, all the products of PCR were verified by direct sequencing. In conclusion, the developed molecular assay allows simultaneous detection and differentiation of N. farcinica , N. cyriacigeorgica and N. beijingensis with high sensitivity and specificity.

1416. Nocardia beijingensis: A Rare and Unusual Cause of Intracranial Abscess

BackgroundNocardia species are thin, aerobic, filamentous, gram-positive bacilli that are ubiquitous in soil worldwide. Nocardia infections are divided into three main categories: pulmonary nocardiosis, disseminated nocardiosis, and cutaneous nocardiosis.MethodsWe present a case of cerebral nocardiosis in an immunocompetent patient caused by Nocardia beijingensis (NB).ResultsA 60-year-old Caucasian lady from Florida with type 2 diabetes mellitus, hypertension, hyperlipidemia, presented to the emergency room with complaints of altered mentation. Per husband, she was having episodes of emesis and diarrhea 3 days prior to admission that resolved however, her mentation significantly deteriorated to where she was unable to perform simple chores around the house. Pertinently she had resection of lung mass 2 months prior to admission which found to be benign. Vital sign at admission was stable and on examination, the patient was alert and oriented, however, lethargic appearing. Neurological examination was pertinent for expressive aphasia; however, cranial nerves II-XII were grossly intact. The patient was also found to have a 3 cm by 4 cm, tender, cystic lesion on the left-sided occipital scalp. The remainder of the physical examination was unremarkable. Admission laboratories were remarkable for leukocytosis and hyperglycemia. MRI of the brain was completed that showed multiple areas of vasogenic edema and multiple nodules with the largest being 1.8 cm suggestive of abscesses. She was started empirically on vancomycin, ceftriaxone, metronidazole, and ampicillin. Cerebral spinal fluid showed neutrophilic pleocytosis, low glucose, and high protein. Initial cultures including CSF were negative. Left-sided occipital scalp lesion was excised and sent for pathology and culture. Initial cultures showed gram-positive bacilli, so antibiotics were de-escalated to sulfamethoxazole/trimethoprim and ceftriaxone. Repeat imaging showed improving abscess, and final cultures resulted in NB.ConclusionNB is believed to have originated in Southeast Asia. NB has been associated mainly with infections in immunocompromised. In the United States, the two only other cases of NB described in immunocompetent hosts were interestingly from Florida as well. Disclosures All authors: No reported disclosures.

Molecular identification and phylogenetic relationships of clinical Nocardia isolates.

Species identification of Nocardia is difficult because of a complex and rapidly evolving taxonomy. In this study, gene sequencing (16S rRNA, gyrB, secA1, hsp65, rpoB), single 16S rRNA gene sequence phylogenetic analysis, and MALDI-TOF analysis were used to accurately identify 46 clinical Nocardia isolates to the species level. This provided a basis for establishing a routine method of multi-locus sequence analysis (MLSA) for molecular identification of Nocardia species. Genetic polymorphism analysis showed that MLSA was a powerfully discriminating method compared with the 16S rRNA gene to identify clinical Nocardia isolates. However, five-locus (gyrB-16S rRNA-secA1-hsp65-rpoB) MLSA led to misidentifications of all of the five Nocardia abscessus, which were confirmed by digital DNA-DNA hybridization (DDH) analysis. Interestingly, four strains identified as Nocardia beijingensis by a 16S rRNA gene phylogenetic tree may be novel species as suggested by DDH studies. For the purpose of achieving both accuracy and discrimination, the data of MLSA were reanalyzed. A three-locus MLSA with concatenated gyrB-16S rRNA-secA1 sequences was used to construct the phylogenetic tree with high accuracy and powerful discrimination. Therefore, a routine method of MLSA was developed to identify clinical Nocardia species.

Slowly Evolving Brain Abscess Caused by Nocardia beijingensis in a Kidney Transplant Patient

Abstract A 71-year-old actively working farmer was admitted because of progressive weakness of the left hand and leg starting 5 weeks before admission. He has been suffering from headaches in the last 4 years. He has undergone kidney transplantation 14 years before admission. Brain magnetic resonance imaging (MRI) revealed a right frontoparietal hypodense lesion measuring 22 × 34 × 17 mm, causing edema, suspected to represent an abscess. Reviewing 2 brain MRI scans performed 4 years 10 months before admission showed a gradually worsening pathological process in the same region. Open surgery revealed an abscess, and drainage was performed. Gram stain and culture from the pus were negative, but panbacterial polymerase chain reaction was positive for Nocardia beijingensis. The patient was treated with ceftriaxone and linezolid for 3 months followed by trimethoprim-sulfamethoxazole. Repeated MRI 2 weeks after drainage showed reduction in abscess size. Brain computed tomography 3 months later showed further improvement. The patient has never recovered and died 8 months later.

Identification and antimicrobial susceptibility of clinical Nocardia species in a tertiary hospital in China.

There is a lack of information on the activities of antimicrobial agents against Nocardia clinical isolates of specific species in China. The aim of this study was to determine the antibiotic susceptibility of 28 clinical isolates of Nocardia spp. isolated from Beijing Chao-Yang Hospital (Beijing, China). Molecular diagnosis of Nocardia spp. was performed using partial 16S rRNA and rpoB gene sequences. Antimicrobial susceptibility testing was performed by broth microdilution according to Clinical and Laboratory Standards Institute (CLSI) recommendations. The species distribution was as follows: Nocardia cyriacigeorgica (n=13); Nocardia farcinica (n=6); Nocardia beijingensis (n=3); Nocardia abscessus (n=2); Nocardia wallacei (n=2); Nocardia otitidiscaviarum (n=1); and Nocardia nova (n=1). The susceptibility rates to trimethoprim/sulfamethoxazole (SXT), linezolid, amikacin, imipenem, tobramycin, ceftriaxone and cefotaxime were 100.0%, 100.0%, 92.9%, 75.0%, 67.9%, 67.9% and 64.3%, respectively, whilst the resistance rate both to ciprofloxacin and clarithromycin was 71.4%. N. cyriacigeorgica was the most frequently isolated Nocardia spp. All clinical isolates showed low susceptibility to ciprofloxacin and clarithromycin and complete susceptibility both to SXT and linezolid, which can be considered the primary choice for the treatment of Nocardia infections in China.

Nocardia xestospongiae sp. nov., isolated from a marine sponge in the Andaman Sea.

A marine sponge-derived actinomycete, strain ST01-07T, was isolated from Xestospongia sp. collected from the Andaman Sea. The strain was characterised taxonomically using a polyphasic approach. The strain contained meso-diaminopimelic acid in the peptidoglycan, whole-cell sugars were arabinose, galactose, glucose, mannose and ribose. Mycolic acids that co-migrated with those from Nocardia araoensis NBRC 100135T were observed in whole-cell extracts. MK-8(H4ω-cycl) was the predominant menaquinone. Major cellular fatty acids were C17 : 1ω8c, C16 : 0 and C17 : 0. The diagnostic phospholipids in the cell consisted of diphosphatidylglycerol, phosphatidylethanolamine and phosphatidylinositol. Phylogenetic analysis based on the 16S rRNA gene sequence showed that strain ST01-07T belonged to the genus Nocardia and was most closely related to N. araoensis IFM 0575T (98.71 % 16S rRNA gene sequence similarity), Nocardia niwae W9241T (98.56 %), Nocardia beijingensis AS4.1521T (98.41 %) and Nocardia arthritidis IFM 10035T (98.36 %). In addition, low DNA-DNA relatedness values (13.6±0.1% to 40.1±0.6%) confirmed that strain ST01-07T represents a novel species of the genus Nocardia, for which the name Nocardia xestospongiae sp. nov., is proposed. The type strain is ST01-07T (=BCC 45622T=NBRC 109069T).

Erratum to “Endobronchial Enigma: A Clinically Rare Presentation of Nocardia beijingensis in an Immunocompetent Patient”

[This corrects the article DOI: 10.1155/2015/970548.].

Endobronchial Enigma: A Clinically Rare Presentation of Nocardia beijingensis in an Immunocompetent Patient.

Nocardiosis is an opportunistic infection caused by the Gram-positive weakly acid-fast, filamentous aerobic Actinomycetes. The lungs are the primary site of infection mainly affecting immunocompromised patients. In rare circumstances even immunocompetent hosts may also develop infection. Diagnosis of pulmonary nocardiosis is usually delayed due to nonspecific clinical and radiological presentations which mimic fungal, tuberculous, or neoplastic processes. The present report describes a rare bronchoscopic presentation of an endobronchial nocardial mass in a 55-year-old immunocompetent woman without underlying lung disease. The patient exhibited signs and symptoms of unresolving community-acquired pneumonia with a computed tomography (CT) scan that showed a space-occupying lesion and enlarged paratracheal lymph node. This patient represents the unusual presentation of pulmonary Nocardia beijingensis as an endobronchial mass. Pathology obtained during bronchoscopy demonstrated polymerase chain reaction (PCR) confirmation of nocardiosis. Symptoms and clinical findings improved with antibiotic treatment. This patient emphasizes the challenge in making the diagnosis of pulmonary nocardiosis, especially in a low risk host. A literature review presents the difficulties and pitfalls in the clinical assessment of such an individual.

Primary cutaneous nocardiosis caused by Nocardia beijingensis

Primary cutaneous nocardiosis caused by Nocardia beijingensis

Primary cutaneous nocardiosis caused by Nocardia beijingensis in an immunocompromised patient with chemotherapy for advanced prostate cancer

Primary cutaneous nocardiosis caused by <i>Nocardia beijingensis</i> in an immunocompromised patient with chemotherapy for advanced prostate cancer

Nocardia beijingensis pulmonary infection successfully treated with intravenous beta-lactam antibiotics and oral minocycline

We report a case of pulmonary infection caused by a rare Nocardia species, Nocardia beijingensis, in a 48-year-old man who received multiple immunosuppressive therapy after renal transplantation. This pathogen was isolated from a bronchoscopic protected specimen brush and was identified as N. beijingensis by 16S rRNA gene sequence analysis. The patient was initially treated with imipenem/cilastatin followed by ceftriaxone and oral minocycline. Traditionally, trimethoprim-sulfamethoxazole (SXT) has been one of the first-line antibiotics chosen as an initial therapy for pulmonary nocardiosis, but this case was successfully treated without SXT. Considering recent reports about failures of both prophylaxis and treatment for nocardial infections with SXT and its various side effects, treatment with beta-lactam antibiotics and minocycline for pulmonary nocardiosis can be chosen in mild to moderate cases with confirmed susceptibility to these antibiotics in vitro.

Nocardia niwae sp. nov., isolated from human pulmonary sources

Members of the genus Nocardia are responsible for cutaneous, pulmonary and disseminated human infections. From 2003 to 2008, four nocardioform strains (W8027, W8681, W9071 and W9241(T)) were isolated from patients in the state of Florida, USA. Ribosomal gene sequencing analysis suggested that a novel species of the genus Nocardia had been isolated. These strains were subjected to a taxonomic analysis using a polyphasic approach. Phenotypic analyses included morphological examination, biochemical profiling and antimicrobial susceptibility testing. Molecular studies included 16S rRNA and DNA gyrase B subunit (gyrB) gene sequence analyses and DNA-DNA hybridization. Phylogenetic neighbours were determined through 16S rRNA and gyrB gene sequence analyses. Phenotypic characteristics that differentiated the novel isolates from phylogenetically related species were growth at 45 °C, and three of the four novel strains utilized l-rhamnose. The antimicrobial profiles could not reliably distinguish the novel species from related nocardiae. Analysis showed that the 16S rRNA gene sequences of the four novel isolates were identical. The blast analysis of the near full-length 16S rRNA gene showed 99.2 % sequence similarity to Nocardia araoensis DSM 44729(T), Nocardia arthritidis DSM 44731(T) and Nocardia beijingensis JCM 10666(T), 98.7 % to Nocardia amamiensis DSM 45066(T), 98.2 % to Nocardia pneumoniae JCM 12119(T) and 97.8 % to Nocardia takedensis JCM 13313(T). Analysis of partial gyrB gene sequences showed that the novel isolates had 95.4 % similarity to N. arthritidis DSM 44731(T), 95.3 % to Nocardia gamkensis DSM 44956(T), 94.4 % to N. pneumoniae JCM 12119(T), 93.8 % to Nocardia asiatica DSM 44668(T), 93.5 % to N. amamiensis DSM 45066(T), 93.4 % to N. beijingensis JCM 10666(T) and 93.2 % to N. araoensis DSM 44729(T). The DNA-DNA relatedness values between the four novel strains were 86-89 %; the relatedness value for strain W9241(T) compared with N. beijingensis JCM 10666(T) was 47 % and 46 % with N. araoensis DSM 44729(T), 44 % with N. arthritidis DSM 44731(T), 32 % with N. amamiensis DSM 45066(T) and 20 % with N. asiatica DSM 44668(T). The results of the taxonomic analysis suggested that the new isolates represent a novel species of the genus Nocardia for which the name Nocardia niwae sp. nov. is proposed. The type strain is W9241(T) (=DSM 45340(T)=CCUG 57756(T)).