Nocardia is a significant opportunistic pathogen in patients with compromised immunity. The authors isolated N. asteroides from an abscess of the axilla and from respiratory specimens of a renal allograft patient with pneumonia. Direct smear of the sputum and bronchial washing specimens showed many branching, filamentous forms which were gram-positive and acid fast. Culture yielded slow growing small white colonies which became orange on further incubation. Aerial hyphae were produced. Identification of the species was based on typical cultural and biochemical tests. The isolate was susceptible to amikacin, minocycline and rifamipicin. The patient became afebrile after 8 weeks of treatment with cotrimoxazole and brief treatment with other antimicrobial agents.
Adult ; Human ; Kidney Transplantation* ; Lung Diseases/etiology* ; Male ; Nocardia Infections/etiology* ; Nocardia asteroides/isolation & purification

Nocardia is an aerobic gram-positive, weak acid-fast, branching, filamentous bacteria causing various clinical infections such as pulmonary nocardiosis, systemic nocardiosis, extrapulmonary nocardiosis, cutaneous nocardiosis and nocardial mycetoma. They are most commonly caused by N. asteroides complex. Humans become infected by inhaling contaminated air-borne dust particles or by traumatic implantation of the bacterium into the subcutaneous tissues. We isolated Nocardia asteroides complex from the hemo-vac of trauma patient and CSFs of two hydrocephalus patients. Nocardia asteroides complex has been isolated less commonly in Korea than in other countries. We think that it is important to extend an incubation time of culture plate when we find the gram positive, branched, beaded filaments and coccoid cells.
Bacteria ; Cerebrospinal Fluid* ; Dust ; Humans ; Hydrocephalus ; Inhalation ; Korea ; Mycetoma ; Nocardia asteroides* ; Nocardia Infections ; Nocardia* ; Subcutaneous Tissue ; Wounds and Injuries*

We report a case of a 42-year-old woman who suffered from recurrent nodular skin lesions on her left foot. Sporotrichoid fungal infection was suspected and two linear nodular skin lesions that had occurred after trauma in a public pool were treated with itraconazole for 4 months. These nodular skin lesions were completely flattened. However, four months after complete flattening, a new lesion developed in the scar of a previous nodule. N. asteroides, which is extremely rare for sporotrichoid cutaneous nocardiosis, was cultured from the relapsed lesion. We treated this case with trimethoprim-sulfamethoxazole for 6 months under an emperical basis and this resulted in complete healing, and sensitivity of N. asteroide to trimethoprim-sulfamethoxazole was confirmed later. There has been no recurrence for 3 years. To our knowledge, our case is the first report in the english literature of primary sporotrichoid cutaneous nocardiosis caused by N. asteroides in terms of anatomic location below the knee and host immunocompetency.
Adult ; Cicatrix ; Female ; Foot ; Humans ; Itraconazole ; Knee ; Nocardia asteroides* ; Nocardia Infections* ; Nocardia* ; Recurrence ; Skin ; Trimethoprim, Sulfamethoxazole Drug Combination

Opportunistic infections are common after a renal transplant as a result of immunosuppression. Nocardiosis is a rare but important cause of morbidity and mortality among renal transplant recipi-ents. Nocardiosis is a localized or disseminated infection, which is usually introduced through the respiratory tract resulting in pneumonia, and may develop a disseminated infection, in particular a subcutaneous abscess and/or central nervous system infection. Because effective therapy for these nocardiosis is available, an accurate and timely diagnosis is crucial. However, nocardiosis is an infrequent disease and many physicians are unfamiliar to it. In addition, in the laboratory, cul-tures may be discarded too early, which often delays an early diagnosis and treatment. The authors isolated Nocardia asteroides from an abscess of the skin in a rejected renal allograft patient suffering pneumonia. The patient was successfully treated with trimethoprim/sulfamethoxa-zole.
Abscess* ; Allografts ; Central Nervous System Infections ; Diagnosis ; Early Diagnosis ; Humans ; Immunosuppression ; Kidney* ; Mortality ; Nocardia asteroides* ; Nocardia Infections ; Nocardia* ; Opportunistic Infections ; Pneumonia ; Respiratory System ; Skin

Nocardia is a kind of aerobic Actinomycetes, gram positive organism that was acid-fast when stained with the modified Ziehl-Neelsen method. Nocardia is a soil saprophyte widely distributed throughout the world which usually introduced through the respiratory tract and may develop a disseminated infection, especially subcutaneous abscess and or central nervous system infection. Nocardiosis is an important opportunistic infection in immunosuppressed patients, lymphoma, sarcoidosis, and organ transplant patient. Sulfonamide therapy is known as a treatment of choice in nocardiosis. We report the two cases of nocardiosis in renal transplant recipient. Nocardia asteroides was isolated in our two cases. We treated sucessfully with Trimethoprim/Sulfamethoxazole(Bactrim).
Abscess ; Actinobacteria ; Central Nervous System Infections ; Humans ; Lymphoma ; Nocardia ; Nocardia asteroides ; Nocardia Infections ; Opportunistic Infections ; Respiratory System ; Sarcoidosis ; Soil ; Transplantation* ; Transplants

Nocardia species are opportunistic pathogens that are known to affect mostly the immunocompromised patients. Recently, we experienced a young systemic lupus erythromatosus female patient having infected with Nocardia species, which we were able to isolate from her lung abscess. The patient is twenty-nine years old female who was diagnosed as having systemic lupus erythromatosus two years ago and is currently engaged with ongoing treatment. During her admission, new symptoms of fever and dyspnea along with a lesion in the apical lobe of her left lung found by simple chest X-rays were observed. Under lung biopsy examination, there were seen neutrophilic exudates that were gram-positive, AFB-negative, and modified AFB-positive. By culturing the biopsy material, we found gram-positive, AFB-negative, and modified AFB-positive branching hyphaes that were morphologically matched for Nocardia species. We have analyzed the Nocardia DNA by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method and found the organism to be Nocardia asteroides type I. Treatment of patient was done using sulfamethoxazole/trimethoprim and ceftriazone, and her clinical conditions as well as her radiological findings improved.
Biopsy ; DNA ; Dyspnea ; Exudates and Transudates ; Female ; Fever ; Humans ; Hyphae ; Immunocompromised Host ; Lung ; Lung Abscess ; Neutrophils ; Nocardia ; Nocardia asteroides* ; Pneumonia* ; Polymerase Chain Reaction ; Thorax

A 52 year-old, contact lens-wearing man presented with progressive right eye pain and redness for one month. He had been evaluated and treated for necrotizing scleritis by multiple eye care specialists prior to presentation. He underwent a complete systemic work-up for both autoimmune and infectious causes of scleritis, including a culture. The culture revealed heavy growth of Nocardia asteroides complexes. The patient was treated with topical amikacin and oral Bactrim. Following several weeks of antibiotic treatment, the patient's infection resolved completely, and his visual acuity returned to baseline status. Nocardia is a rare but potentially devastating cause of necrotizing scleritis that may affect contact lens wearers without an associated keratitis. Prompt recognition and early treatment with appropriate antimicrobial agents are critical to achieve a favorable outcome.
Anti-Bacterial Agents/therapeutic use ; Contact Lenses/*adverse effects/*microbiology ; Humans ; Male ; Middle Aged ; Nocardia Infections/*diagnosis/drug therapy ; Nocardia asteroides/*isolation & purification ; Scleritis/drug therapy/*microbiology

Nocardiosis is an acute, subacute, or chronic infection, most often beginning in the lung, and usually affects the immunocompromised host. Nocardial infections are not rare in the United States, 500 to 1000 cases are recognized each year, but rarely reported in Korea. Disorders associated with cellular immune dysfunction are the major risk factors for nocardiosis. We report one case of brain and retroperitoneal abscess caused by Nocardia asteroides in patient who has had a chronic lymphocytic leukemia and diabetes mellitus, with a review of the relevant literature.
Abscess ; Brain ; Diabetes Mellitus ; Humans ; Immunocompromised Host ; Korea ; Leukemia, Lymphocytic, Chronic, B-Cell* ; Lung ; Nocardia asteroides ; Nocardia Infections* ; Risk Factors ; United States

Nocardiosis is an uncommon Gram-positive bacterial infection caused by aerobic actinomycetes in the genus Nocardia. Nocardia spp. have the ability to cause localized or systemic suppurative disease in humans and animals. Nocardiosis is typically regarded as an opportunistic infection, but approximately one-third of infected patients are immunocompetent. We report a rare case of pulmonary nocardiosis and a brain abscess caused by Nocardia asteroides in an elderly woman with a history of Crohn's disease. Radiographic imaging revealed a contrast-enhancing lesion with perilesional parenchymal edema that was preoperatively thought to be a neoplasm. The patient experienced aggressive disease progression simulating a metastatic brain tumor. Early diagnosis of norcadiosis, the absence of underlying disease, and the administration of appropriate antibiotics has a positive impact on prognosis. Familiarity with the magnetic resonance and computed tomography findings associated with CNS nocardiosis, such as those presented here, is essential for making an early diagnosis.
Actinobacteria ; Aged ; Animals ; Anti-Bacterial Agents ; Brain ; Brain Abscess ; Brain Neoplasms ; Crohn Disease ; Disease Progression ; Early Diagnosis ; Edema ; Female ; Gram-Positive Bacterial Infections ; Humans ; Magnetic Resonance Spectroscopy ; Nocardia ; Nocardia asteroides ; Nocardia Infections ; Opportunistic Infections ; Prognosis ; Recognition (Psychology)

Nocardiosis is a rare opportunistic infection and only sporadic cases were reported in systemic lupus erythematosus (SLE). We report a case of a nocardial infection in a patient with SLE. A 37-year-old woman was admitted to our hospital because of general weakness and edema. She had been diagnosed as SLE in 1995 and was diagnosed as lupus nephritis (class IV, diffuse proliferative glomerulonephritis) in 1999, but had refused the treatment for SLE. After admission, she was diagnosed as active SLE with lupus nephritis based on clinical and laboratory findings. She was treated with methylprednisolone pulse (1 gx3 days) and cyclophosphamide pulse (750 mg) therapy followed by daily high dose oral prednisone (60 mg) and plasmapheresis (7 times). On 32 days after admission, chest radiograph revealed a massive pleural effusion. The pleural fluid was exudate and cultures for bacteria, fungi and tubercle bacilli were negative and pleural biopsy showed mesothelial thickening. The thoracentesis was done (1 L), but the effusion recurred within 3 days. Further four thoracentesis and thoracostomy were performed due to recurrent massive pleural effusion. On 60 days after admission, thoracostomy tube was removed, but 4 days later, fever occurred and Nocardia asteroides was cultured in pleural fluid. Treatment with oral trimethoprim/sulfamethoxazole (TMP-SMX, 160~800 mg) was started. After treatment with TMP-SMX, the pleural effusion decreased. On 76 days after admision, she was discharged and maintained on TMP-SMX (80~400 mg) for another 12 months. At present, her SLE activity is on control and has no pleural effusion.
Adult ; Bacteria ; Biopsy ; Cyclophosphamide ; Edema ; Exudates and Transudates ; Female ; Fever ; Fungi ; Humans ; Lupus Erythematosus, Systemic* ; Lupus Nephritis ; Methylprednisolone ; Nocardia asteroides ; Nocardia Infections ; Opportunistic Infections ; Plasmapheresis ; Pleural Effusion ; Prednisone ; Radiography, Thoracic ; Thoracostomy ; Trimethoprim, Sulfamethoxazole Drug Combination