Nocardiosis is uncommon in healthy people, but occurs as an opportunistic infection in patients with connective tissue disease, solid organ transplantation, lung disease, malignancies, and the acquired immune deficiency syndrome (AIDS). Nocardia is a gram positive, variably acid-fast aerobic bacterium of the family Nocardiaceae characterized by branching and filamentous growth, with distinctive aerial hyphae. In systemic lupus erythematosus (SLE) patients, immunosuppressiion with cytotoxic drugs or corticosteroids, proteinuria, renal insufficiency, and active SLE itself are known as risk factors for serious bacterial infections and opportunistic infections. We report a case of pulmonary Nocardiosis in patient with lupus nephritis treated with cyclophosphamide and high dose corticosteroid.
Acquired Immunodeficiency Syndrome ; Adrenal Cortex Hormones ; Bacterial Infections ; Connective Tissue Diseases ; Cyclophosphamide ; Humans ; Hyphae ; Lung Diseases ; Lupus Erythematosus, Systemic ; Lupus Nephritis* ; Nocardia ; Nocardia Infections* ; Nocardiaceae ; Opportunistic Infections ; Organ Transplantation ; Proteinuria ; Renal Insufficiency ; Risk Factors ; Transplants

From 1996 to 2014, 14 foals from nine farms in Jeju were diagnosed with a Rhodococcus equi infection. Clinically, most foals showed characteristic respiratory signs, including hyperthermia and dyspnea. The seasonal occurrence of R. equi infection in foals was higher in summer, such as June (eight foals; 57.1%) and July (four foals; 28.6%), than in the other seasons. The major cases of R. equi infections were observed among two-month-old (eight foals; 57.1%) and three-month-old (three foals; 21.4%) foals. Histopathologically, bronchopneumonia, abscess, and granulomatous pneumonia were the most prevalent lesions in the lungs of foals. Colonic ulcers and submucosal abscesses were found in a foal. Some foals showed granulomatous lymphadenitis and abscesses in the mesenteric and other lymph nodes. According to the polymerase chain reaction using 10 tissue samples of foals and nine R. equi isolates, the vapA gene was detected in 11/11 (100%) foals. Immunohistochemical staining using the anti-VapA monoclonal antibody was applied to detect the R. equi VapA antigen in the organs of foals. R. equi VapA antigens were demonstrated in most lungs and some mesenteric and hilar lymph nodes of 13 foals. Isolated virulent R. equi VapA bacteria showed high sensitivity to gentamicin, quinolones, rifampin, and vancomycin.
Abscess ; Agriculture ; Bacteria ; Bronchopneumonia ; Colon ; Dyspnea ; Fever ; Gentamicins ; Immunohistochemistry ; Lung ; Lymph Nodes ; Lymphadenitis ; Pneumonia ; Polymerase Chain Reaction ; Quinolones ; Rhodococcus equi ; Rhodococcus ; Rifampin ; Seasons ; Ulcer ; Vancomycin

BACKGROUNDRhodococcus equi (R. equi) infection commonly occurs in grazing areas, especially in patients with AIDS or with T-lymphocyte immuno-deficiencies. Literature reviews revealed that cases radiologically and pathologically diagnosed of AIDS complicated by R. equi infection are rare. This study aimed to investigate the imaging features and pathological basis of AIDS complicated by pulmonary R. equi infection.

METHODSA total of 13 cases of AIDS complicated by pulmonary R. equi infection were retrospectively analyzed based on their imaging, bacterial culture and pathological data, including 10 cases by chest CT scanning and X-ray radiology and 3 cases by only X-ray radiology. All 13 cases were definitely diagnosed by bacterial culture, including one by CT-guided pulmonary puncture with following H&E staining and periodic acid-Schiff (PAS) staining for diagnostic biopsy and another one by bronchial biopsy with following H&E staining and PAS staining for pathological diagnosis. The imaging findings and the pathological findings of AIDS complicated by pulmonary R. equi infection were compared and evaluated.

RESULTSTotally 9 subjects (70%) had radiological demonstrations of central ball liked high density shadows in unilateral pulmonary hilus areas; 10 (77%), cavities and liquefied levels; 3 (23%), pleural effussion. The foci were found in pulmonary inner zone in 10 subjects (77%) and in pulmonary outer zone in one subject (7%). The pathological findings included intra-alveolar hemorrhage, lymphocyte infiltration and granulation tissue proliferation, which were in line with the pathological process of necrotic pneumonia. After 8-month follow-up of anti-R. equi therapy of these 13 cases, 9 cases had obviously decreased or shrunk pulmonary cavities, one died, one missed follow-up, one completely absorbed foci and one did not receive reexaminations.

CONCLUSIONSThe radiological demonstrations of AIDS complicated by pulmonary R. equi infection are central ball liked high density areas in unilateral pulmonary hilus area, parenchymal changes, secondary cavities, ground glass liked changes in the lung fields, nodules and treeinbuds sign, which are characteristic rather than specific.

Acquired Immunodeficiency Syndrome ; diagnosis ; diagnostic imaging ; Actinomycetales Infections ; diagnosis ; diagnostic imaging ; Adult ; Female ; Humans ; Lung Diseases ; microbiology ; Male ; Middle Aged ; Radiography ; Rhodococcus equi ; pathogenicity ; Young Adult

The cultural conditions for the growth of Norcardia cell were studied in this paper. Controlling pH value, adding nutrient and optimizing the quantity of inducer during cultivation, the activity of nitrile hydratase reached 6567 u/mL (culture medium), which was the highest value appeared in native journals. In the farther hydratase experiments, no by-product, crylic acid, was detected. It showed that the activity of amidase was not promoted obviously while the activity of nitrile hydratase was increased greatly. The results set a strong foundation for the industrial application and the research on new technology.
Acrylamides ; metabolism ; Amidohydrolases ; metabolism ; Biotechnology ; methods ; Cell Culture Techniques ; Fermentation ; physiology ; Glucose ; metabolism ; Hydro-Lyases ; metabolism ; Hydrogen-Ion Concentration ; Nocardiaceae ; enzymology ; metabolism

We report a case of catheter-related bacteremia due to Tsukamurella pulmonis. T. pulmonis is a rare cause of opportunistic infection in immunosuppressed patients and in cases of indwelling foreign materials. This infection was nearly impossible to identify using conventional phenotyping methods because of its similarities to the related genera Nocardia, Rhodococcus, Gordonia, Streptomyces, Corynebacterium, and Mycobacterium. This organism was initially misidentified as Mycobacterium aubagnense through PCR-RFLP analysis. We correctly identified this organism using 16S rRNA sequencing combined with phenotyping tests.
Bacteremia ; Catheters ; Corynebacterium ; Humans ; Korea ; Mycobacterium ; Nocardia ; Nontuberculous Mycobacteria ; Opportunistic Infections ; Rhodococcus ; Streptomyces

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

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

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