MycologyLymphocutaneous nocardiosis due to Nocardia brasiliensis
Introduction
Human nocardiosis is increasing worldwide, especially among immunocompromised patients. In the United States the frequency of nocardiosis has been estimated to be between 500 and 1000 cases per year (Beaman et al., 1976). In France 120 to 250 new cases of nocardiosis are diagnosed each year (Boiron et al., 1992). Nocardia brasiliensis accounts for only about 7% of clinical nocardial disease. Although these species are responsible for pulmonary and disseminated disease, they are more frequently associated with progressive cutaneous and lymphocutaneous infections (Smego & Gallis, 1984). Traumatic inoculation of the organism into the skin is the most typical mode of acquisition of this infection. The following is a presentation of a case of primary lymphocutaneous infection seen in the University Hospital of Crete, Greece. This is the first reported Greek case of this disease.
Section snippets
Case report
A previously healthy 64-year-old man was referred to the emergency department of the University Hospital in March 2002, with a painful erythematous lesion in the first interdigital space of his left hand. The patient reported that two weeks prior to admission was punctured by a palm tree leaf while he was working in his garden. Despite local wound care and topical antimicrobial agents the lesion was progressively becoming more extensive and ten days later was complicated with painful
Microbiologic studies
The purulent material was inoculated onto Sabouraud dextrose agar, Columbia agar with 5% sheep blood, chocolate agar plates and incubated at 35°C.
PCR and DNA sequencing
PCR products were generated by using the following primers derived from the 16S rRNA gene of Nocardia spp. conserved segments: 5′ TAAATTAACCCTCACTAAAGGGAACGCTGGCGGCGTGCTTAA3′, and 5′ ATCAGGAAACAGCTATGACCAGGTGATCCAGCCGCACCTT 3′. The underlined part corresponds to the 16S rRNA-specific part and the 5′ non underlined part corresponds to sequencing
Results
Colonies were noted on Columbia blood agar, chocolate agar and Sabouraud dextrose agar after 5 days of incubation. The culture plates exhibited a characteristic earthy-odor, and colonies with a chalky-white color appearance were rough with a velvety surface due to the aerial filamentation. Microscopically, the isolate produced Gram-positive, fine, branching filaments with a tendency to fragment into bacillary forms. Additionally, the cultured organisms were partially acid-fast when stained with
Discussion
Nocardia is a genus comprised of aerobic Gram-positive, filamentous bacteria that belong to the family Nocardiaceae (Brown et al., 1999). Nocard first described the microorganism in 1888 and Eppinger reported the first human case of nocardiosis in 1890 (Sorrell et al., 2000).
The following species are recognized as etiologic agents of clinical nocardiosis in humans: N. asteroides, N. brasiliensis, N. pseudobrasiliensis, N. brevicatena, N. farcinica, N. nova, N. otidiscaviarum, and N.
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