Mycology
Lymphocutaneous nocardiosis due to Nocardia brasiliensis

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Abstract

Nocardia species are Gram-positive bacteria responsible for systemic or cutaneous infections in humans. Nocardia brasiliensis is the most common infective agent in the cutaneous form of nocardiosis. We describe a case of a previously healthy man, who presented with lymphocutaneous Nocardia brasiliensis infection, and was successfully treated with trimethoprim-sulfamethoxazole. The identification of the isolate was confirmed by nucleotide sequence analysis of the 16S rRNA gene.

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.

References (24)

  • R.E. Kalb et al.

    Cutaneous nocardiosiscase reports and review

    J Am Acad Dermatol

    (1985)
  • J.G. Schwartz et al.

    Primary lymphocutaneous Nocardia brasiliensis infectionthree case reports and a review of the literature

    Diagn Microbiol Infect Dis

    (1988)
  • B.L. Beaman et al.

    Nocardial infections in the United States, 1972-1974

    J Infect Dis

    (1976)
  • R.R. Belliveau et al.

    Lymphocutaneous Nocardia brasiliensis infection simulating sporotrichosis

    West J Med

    (1977)
  • D. Berd

    Nocardia brasiliensis infection in the United Statesa report of nine cases and review of the literature

    Am J Clin Pathol

    (1973)
  • P. Boiron et al.

    Review of nocardial infections in France 1987-1990

    Eur J Clin Microbiol Infect Dis

    (1992)
  • Brown, J. M., McNeil, M. M. & Desmond, E. P. (1999). Nocardia, Rhodococcus, Gordona, Actinomadura, Streptomyces, and...
  • P.R. Georghiou et al.

    Infections with Nocardia species in Queenslanda review of 102 clinical isolates

    Med J Aust

    (1992)
  • A. Gonzalez-Ochoa et al.

    Different degrees of morbidity, in the white mouse, induced by Nocardia brasiliensis,

    Nocardia asteroides and Nocardia caviae. Sabouraudia

    (1976)
  • D.L. Kiska et al.

    Identification of medically relevant Nocardia species with an abbreviated battery of tests

    J Clin Microbiol

    (2002)
  • F. Laurent et al.

    Ribotyping: a tool for taxonomy and identification of the Nocardia asteroides complex species

    J Clin Microbiol

    (1996)
  • P.I. Lerner

    Nocardiosis

    Clin Infect Dis

    (1996)
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