1887

Abstract

Background . Nocardia are aerobic partially acid-fast bacteria that are environmentally ubiquitous. This group of bacteria causes a rare bacterial infection of either the lungs (pulmonary) or body (systemic) that usually affects immunocompromised individuals. Nocardia mexicana was first isolated in 2004 from a patient with chronic bronchitis. However, there have been few reports on the clinical significance of this organism up to now. We herein report the first cases of N. mexicana in patients with pulmonary and cutaneous infection from Iran.

Case presentation. A 57-year-old man was admitted to hospital due to a cutaneous wound on his left foot, fever, weakness, persistent cough and chest pain. At first, due to clinical examination and laboratory test, the patient was diagnosed as having tuberculosis. However, PCR of Mycobacterium tuberculosis was negative from broncho-alveolar lavage (BAL) samples. Direct PCR of BAL was performed for this patient and according to the clinical examinations and microbiological evaluations; the micro-organism was identified as N. mexicana and was isolated from both BAL and the wound. Finally, the patient was treated with linezolid and amikacin.

Conclusions. The infections, with actinomycetes such as Nocardia , are easily neglected or misdiagnosed due to the fastidious nature of the organism and the inadequate microbiological experience of laboratories in the hospitals of developing countries. This case shows that hospitals should consider a better laboratory protocol to deal with the clinical cases in which fastidious organisms, and in particular Nocardia , are involved.

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2019-04-23
2019-08-23
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References

  1. Minero MV, Marín M, Cercenado E, Rabadán PM, Bouza E et al. Nocardiosis at the turn of the century. Medicine 2009;88:250–261 [CrossRef]
    [Google Scholar]
  2. Nocard E. Note sur la Maladie des boeufs de la Guadeloupe connuesous Le nom de farcin. Ann Inst Pasteur 1888;2:293–302
    [Google Scholar]
  3. Saubolle MA, Sussland D. Nocardiosis: review of clinical and laboratory experience. J Clin Microbiol 2003;41:4497–4501 [CrossRef]
    [Google Scholar]
  4. Kontoyiannis DP, Ruoff K, Hooper DC. Nocardia bacteremia: report of 4 cases and review of the literature. Medicine 1998;77:255–267 [CrossRef]
    [Google Scholar]
  5. Budzik JM, Hosseini M, Mackinnon Jr AC, Taxy JB. Disseminated Nocardia farcinica: literature review and fatal outcome in an immunocompetent patient. Surg Infect 2012;13:163–170 [CrossRef]
    [Google Scholar]
  6. Ambrosioni J, Lew D, Garbino J. Nocardiosis: updated clinical review and experience at a tertiary center. Infection 2010;38:89–97 [CrossRef]
    [Google Scholar]
  7. Kim S, Lee KL, Lee DM, Jeong JH, Moon SM et al. Nocardia brain abscess in an immunocompetent patient. Infect Chemother 2014;46:45–49 [CrossRef]
    [Google Scholar]
  8. Rodriguez-Nava V, Couble A, Molinard C, Sandoval H, Boiron P et al. Nocardia mexicana sp. nov., a new pathogen isolated from human mycetomas. J Clin Microbiol 2004;42:4530–4535 [CrossRef]
    [Google Scholar]
  9. Raby E, Hiew V, Arthur I. A case of Nocardia mexicana cerebral abscess highlights deficiencies in susceptibility testing and the utility of direct molecular identification. Pathology 2016;48:508–510 [CrossRef]
    [Google Scholar]
  10. Ikeda T, Nakanishi H, Morishita Y, Houdai K, Ito J et al. First case report of pulmonary nocardiosis caused by Nocardia mexicana. JMM case reports 2016;3:
    [Google Scholar]
  11. Owen H, Buckle K, Olm J, Leitner M, Pandey S et al. Isolation of Nocardia mexicana from focal proliferative tenosynovitis and arthritis in a steer. Aust Vet J 2015;93:170–173 [CrossRef]
    [Google Scholar]
  12. Laurent FJ, Provost F, Boiron P. Rapid identification of clinically relevant Nocardia species to genus level by 16S rRNA gene PCR. J Clin Microbiol 2000;38:2805
    [Google Scholar]
  13. Roth A, Andrees S, Kroppenstedt RM, Harmsen D, Mauch H. 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. J Clin Microbiol 2003;41:851–856 [CrossRef]
    [Google Scholar]
  14. Jeon YS, Chung H, Park S, Hur I, Lee JH et al. jPHYDIT: a JAVA-based integrated environment for molecular phylogeny of ribosomal RNA sequences. Bioinformatics 2005;21:3171–3173 [CrossRef]
    [Google Scholar]
  15. Hashemi-Shahraki A, Heidarieh P, Bostanabad SZ, Hashemzadeh M, Feizabadi MM et al. Genetic diversity and antimicrobial susceptibility of Nocardia species among patients with nocardiosis. Sci Rep 2016;5:17862 [CrossRef]
    [Google Scholar]
  16. Brown-Elliott BA, Brown JM, Conville PS, Wallace RJ. Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clinl microbiol rev 2006;19:259–282 [CrossRef]
    [Google Scholar]
  17. DeWitt JP, Stetson CL, Thomas KL, Carroll BJ. Extensive cutaneous botryomycosis with subsequent development of Nocardia-positive wound cultures. J Cutan Med Surg 2018;22:344–346 [CrossRef]
    [Google Scholar]
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