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. 2013 Summer;24(2):e33-8.
doi: 10.1155/2013/256025.

Molecular identification and susceptibility pattern of clinical Nocardia species: Emergence of Nocardia crassostreae as an agent of invasive nocardiosis

Saad J Taj-Aldeen  1 , Anand Deshmukh  1 , Sanjay Doiphode  1 , Atqah Abdul Wahab  2 , Mona Allangawi  3 , Ahmed Almuzrkchi  4 , Corné H Klaassen  5 , Jacques F Meis  5
Affiliations

Molecular identification and susceptibility pattern of clinical Nocardia species: Emergence of Nocardia crassostreae as an agent of invasive nocardiosis

Saad J Taj-Aldeen et al. Can J Infect Dis Med Microbiol. 2013 Summer.

Abstract
in English, French

Background: Nocardia species are rare, opportunistic organisms that cause disease in both immunocompetent and immunocompromised individuals.

Objective: To investigate the clinical presentations of various Nocardia infections based on the 16S ribosomal RNA gene of the isolate, as well as related risk factors and susceptibility patterns to antimicrobial agents.

Methods: Thirteen patients with a diagnosis of nocardiosis were included in the present study. Seven Nocardia species were identified by 16S ribosomal RNA. Susceptibility testing was performed using six antimicrobial agents.

Results: Five patients were immunocompromised, and eight were immunocompetent with predisposing factors including cystic fibrosis, tuberculosis and ophthalmic infections. Nocardia caused pulmonary infections in eight patients (61.5%), invasive systemic infections in three patients (23%) and local (ophthalmic) infections in two patients (15.4%). In the patients with pulmonary disease, nocardiosis was caused by six species (Nocardia cyriacigeorgica, Nocardia otitidiscaviarum, Nocardia farcinica, Nocardia carnea, Nocardia testacea and Nocardia asiatica). The seventh species identified in the present study was Nocardia crassostreae.

Discussion: N crassostreae is a multidrug-resistant organism that was reported to be an emerging human pathogen causing invasive nocardiosis in a patient with non-Hodgkin's lymphoma. N farcinica was isolated from blood in a patient with breast cancer. None of the Nocardia isolates were resistant to linezolid. One N otitidiscaviarum isolate was a multidrug-resistant organism. All patients in the present study were treated with the appropriate antibiotics and their condition resolved without further sequelae.

Conclusions: The present study is the first report on N crassostreae as a human pathogen. The detection of multidrug-resistant species necessitate molecular identification and susceptibility testing, and should be performed for all Nocardia infections. Nocardiosis manifests various clinical features depending on the Nocardia species and underlying conditions.

Historique: Les espèces de Nocardia sont des organismes opportunistes rares qui sont pathogènes à la fois chez les personnes immunocompétentes et immunodéprimées.

Objectif: Explorer la présentation clinique de diverses infections à Nocardia d’après le gène d’ARN ribosomique 16S de l’isolat, ainsi que les facteurs de risque connexes et les profils de susceptibilité aux antimicrobiens.

Méthodologie: Treize patients ayant un diagnostic de nocardiose ont participé à la présente étude. Les chercheurs ont repéré sept espèces de Nocardia au moyen de l’ARN ribosomique 16S. Ils ont effectué les tests de susceptibilité à six antimicrobiens.

Résultats: Cinq patients étaient immunodéprimés et huit étaient immunocompétents, mais présentaient des facteurs de prédisposition, y compris la fibrose kystique, la tuberculose et des infections ophtalmiques. La Nocardia a provoqué des infections pulmonaires chez huit patients (61,5 %), des infections systémiques invasives chez trois patients (23 %) et des infections locales (ophtalmiques) chez deux patients (15,4 %). Chez les patients atteints d’une maladie pulmonaire, la nocardiose était attribuable à six espèces (Nocardia cyriacigeorgica, Nocardia otitidiscaviarum, Nocardia farcinica, Nocardia carnea, Nocardia testacea et Nocardia asiatica). La septième espèce observée dans la présente étude était la Nocardia crassostreae.

Exposé: La N crassostreae, un organisme multirésistant considéré comme un agent anthropopathogène émergent, était responsable d’une nocardiose invasive chez un patient atteint d’un lymphome non hodgkinien. Les chercheurs ont isolé le N farcinica dans le sang d’un patient atteint d’un cancer du sein. Aucun des isolats de Nocardia n’était résistant à la linézolide. Un isolat de N otitidiscaviarum était multirésistant. Tous les patients participant à la présente étude ont reçu un traitement aux antibiotiques pertinent et se sont rétablis sans autres séquelles.

Conclusion: La première étude est la première à faire état de la N crassostreae comme agent anthropopathogène. Pour déceler les espèces multirésistantes, il faut procéder à une identification moléculaire et à un test de susceptibilité, des mesures qu’il faudrait prendre à l’égard de toutes les infections à Nocardia. La nocardiose s’associe à diverses caractéristiques cliniques, selon l’espèce de Nocardia et les maladies sousjacentes.

Keywords: Antibiotic susceptibility; Clinical cases; Molecular identification; Nocardia; Nocardia crassostreae.

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Figures

Figure 1)
Figure 1)
Magnetic resonance image of a patient (case 1) with pulmonary nocardiosis and dissemination to an abscess approximately 3.5 cm in diameter with thick wall (arrow) in the left lumborum muscle at level of L1 vertebral body caused by Nocardia cyriacigeorgica
Figure 2)
Figure 2)
Computed tomography scan shows a large abscess caused by Nocardia crassostreae, in the left psoas muscle (solid arrow) extending outward and producing a multiloculated abscess (open arrow) in the left lumborum muscle (case 11)
Figure 3)
Figure 3)
Chest computed tomography scan of an immunocompetent patient (case 3). A small area of consolidation in the inferior segment of lingual (left lung) caused by Nocardia cyriacigeorgica is apparent
See this image and copyright information in PMC

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