Pathogenic Nocardia isolated from clinical specimens including those of AIDS patients in Thailand

A Rare Symptom of Secondary Infection After Facial Thread Lift and Its Treatment

Facial esthetics is concerned with the harmonious beauty of the face. The skin, soft tissues, and bone tissues of the face degenerate as people age. Facial thread lift is a new minimally invasive esthetic technique that uses threads embedded within different tissue layers to reposition and support lax tissues. The authors report a 35-year-old female patient who developed an infection after undergoing facial thread lift, presenting with facial flushing and swelling, fever, and poor sleep, which was tested for Nocardiopsis dassonvillei infection. The patient was later cured by thread removal, local injection of 5-fluorouracil and triamcinolone acetonide. Postthreading infections have been documented in the past, but it is significant to note that, first, this patient's postinfection symptoms were distinct because she experienced both mild local symptoms and serious systemic symptoms, and second, the authors looked into a quick and efficient treatment option.

Genomic Virulence Features of Two Novel Species Nocardia barduliensis sp. nov. and Nocardia gipuzkoensis sp. nov., Isolated from Patients with Chronic Pulmonary Diseases

Strains 335427^T and 234509^T, isolated from two 76-year-old patients with chronic pulmonary diseases, were the subject of polyphasic taxonomic studies and comparative genomic analyses for virulence factors. The 16 rRNA gene sequence similarity between strains 335427^T and 234509^T and their closest phylogenetic neighbors Nocardia asiatica NBRC 100129^T and Nocardia abscessus NBRC 100374^T were 99.5% and 100%, respectively. Digital DNA-DNA hybridization values between the aforementioned studied strains were well below the 70% threshold for assigning prokaryotic strains to a novel species. Strains 335427^T and 234509^T have genome sizes of 8.49 Mpb and 8.07 Mpb, respectively, with G + C content of 68.5%. Isolate 335427^T has C_16:0, C_18:1 ω₉c, C_18:0 and C_18:0 10 methyl as major fatty acids (>15%) and mycolic acids formed of 52-54 carbon atoms. However, only C_18:1 ω₉c was detected for isolate 234509^T, which had mycolic acids with 44-56 carbon. Based on phenotypic and genetic data, strains 335427^T (DSM 109819^T = CECT 9924^T) and 234509^T (DSM 111366^T = CECT 30129^T) merit recognition as novel species, which are named Nocardia barduliensis sp. nov. and Nocardia gipuzkoensis sp. nov., respectively. All the strains studied had homologous VF-associated genes to those described in M. tuberculosis, including experimentally verified virulence genes in humans related to tuberculosis. The narGHIJ (nitrate reduction pathway) and gvpAFGOJLMK (gas vesicles) genetic maps of strains 335427^T, 234509^T, NBRC 100129^T and NBRC 100374^T showed the same syntenic block and raise the question of whether their functions are interlinked during the infection of the human host. However, further research is required to decipher the role of the gas vesicle in the pathogenicity mechanism of Nocardia spp.

Nocardia transvalensisDisseminated Infection in an Immunocompromised Patient with Idiopathic Thrombocytopenic Purpura

Nocardia transvalensis complex includes a wide range of microorganisms with specific antimicrobial resistance patterns. N. transvalensis is an unusual Nocardia species. However, it must be differentiated due to its natural resistance to aminoglycosides while other Nocardia species are susceptible. The present report describes a Nocardia species involved in an uncommon clinical case of a patient with idiopathic thrombocytopenic purpura and pulmonary nocardiosis. Microbiological and molecular techniques based on the sequencing of the 16S rRNA gene allowed diagnosis of Nocardia transvalensis sensu stricto. The successful treatment was based on trimethoprim-sulfamethoxazole and other drugs. We conclude that molecular identification of Nocardia species is a valuable technique to guide good treatment and prognosis and recommend its use for daily bases diagnosis.

Nocardia isolation from clinical samples with the paraffin baiting technique

BACKGROUND

The genus Nocardia is a cause of infection in the lungs, skin, brain, cerebrospinal fluid, eyes, joints and kidneys. Nocardia isolation from polymicrobial specimens is difficult due to its slow growth. Several methods have been reported for Nocardia isolation from clinical samples. In the current study, we used three methods: paraffin baiting technique, paraffin agar, and conventional media for Nocardia isolation from various clinical specimens from Iranian patients.

METHODS

In this study, we examined 517 samples from various clinical specimens such as: sputum of patients with suspected tuberculosis, bronchoalveolar lavage, sputum of patients with cystic fibrosis, tracheal aspirate, cutaneous and subcutaneous abscesses, cerebrospinal fluid, dental abscess, mycetoma, wound, bone marrow biopsy, and gastric lavage. All collected specimens were cultured on carbon-free broth tubes (paraffin baiting technique), paraffin agar, Sabouraud dextrose agar, and Sabouraud dextrose agar with cycloheximide and were incubated at 35°C for one month.

RESULTS

Seven Nocardia spp. were isolated with paraffin baiting technique, compared with 5 positive results with the paraffin agar technique and 3 positive results with Sabouraud dextrose agar with and without cycloheximide. The prevalence of nocardial infections in our specimens was 5.28%.

CONCLUSION

In the present study, the use of the paraffin baiting technique appeared to be more effective than other methods for Nocardia isolation from various clinical specimens.

Molecular identification of nocardia isolates from clinical samples and an overview of human nocardiosis in Brazil

BACKGROUND

Nocardia sp. causes a variety of clinical presentations. The incidence of nocardiosis varies geographically according to several factors, such as the prevalence of HIV infections, transplants, neoplastic and rheumatic diseases, as well as climate, socio-economic conditions and laboratory procedures for Nocardia detection and identification. In Brazil the paucity of clinical reports of Nocardia infections suggests that this genus may be underestimated as a cause of human diseases and/or either neglected or misidentified in laboratory specimens. Accurate identification of Nocardia species has become increasingly important for clinical and epidemiological investigations. In this study, seven clinical Nocardia isolates were identified by multilocus sequence analysis (MLSA) and their antimicrobial susceptibility was also determined. Most Nocardia isolates were associated to pulmonary disease.

METHODOLOGY/PRINCIPAL FINDINGS

The majority of Brazilian human isolates in cases reported in literature were identified as Nocardia sp. Molecular characterization was used for species identification of Nocardia nova, Nocardia cyriacigeorgica, Nocardia asiatica and Nocardia exalbida/gamkensis. Data indicated that molecular analysis provided a different Nocardia speciation than the initial biochemical identification for most Brazilian isolates. All Nocardia isolates showed susceptibility to trimethoprim-sulfamethoxazole, the antimicrobial of choice in the treatment nocardiosis. N. nova isolated from different clinical specimens from one patient showed identical antimicrobial susceptibility patterns and two distinct clones.

CONCLUSIONS/SIGNIFICANCE

Although Brazil is the world's fifth-largest country in terms of land mass and population, pulmonary, extrapulmonary and systemic forms of nocardiosis were reported in only 6 of the 26 Brazilian states from 1970 to 2013. A least 33.8% of these 46 cases of nocardiosis proved fatal. Interestingly, coinfection by two clones may occur in patients presenting nocardiosis. Nocardia infection may be more common throughout the Brazilian territory and in other developing tropical countries than is currently recognized and MLSA should be used more extensively as an effective method for Nocardia identification.

Disseminated Nocardia otitidiscaviarum in a patient with AIDS

A case of disseminated infection due to Nocardia otitidiscaviarum is described in a Caucasian man infected with the human immunodeficiency virus. The patient presented with no previous AIDS-defining conditions, a CD4 lymphocyte count of 206 cells/mm(3) and enlarging intra-abdominal and chest wall abscesses with bilateral pulmonary infiltrates. Aggressive surgical debridement and antimicrobial therapy with trimethoprim/sulfamethoxazole and amikacin resulted in clinical cure. Long term suppressive therapy was needed to prevent relapse.

Systemic nocardiosis caused by Nocardia concava in China

A 42-year-old man with polychondritis and a 2-year history of using low-dose prednisone and other immunosuppressive drugs was admitted to our hospital due to persistent high fever of 10 days duration. A strain of Nocardia was twice isolated from his blood and subsequently identified to be N. concava. The patient was initially treated with sulphadiazine sodium, vancomycin and imipenema for 7 days but the symptoms persisted. Consequently, the regimen was changed to sulphadiazine sodium, ciprofloxacin and amikacin sulfate based on the antibiotic susceptibility tests of the Nocardia isolate. The fever disappeared and the patient's condition improved after 10 days of this treatment to the extent that he was discharged. However, 7 days later, the patient's condition deteriorated and he died due to multiple organ failure. This is the first report of N. concava causing systemic nocardiosis in China.

Lymphocutaneous type of nocardiosis caused by Nocardia vinacea in a patient with polymyositis

We report a lymphocutaneous type of nocardiosis caused by Nocardia vinacea. A 62-year-old woman with polymyositis presented with some erythematous swellings and subcutaneous abscesses on her right middle finger and the dorsum of her hand, which had persisted for 2 weeks. Culturing of the excised nodule and pus revealed orange to orange-tan colonies with scanty whitish aerial mycelia. The isolate was identified as N. vinacea on the basis of its biochemical and chemotaxonomic characteristics and the results of molecular biological analysis. In our case, oral minocycline (MINO) and trimethoprim-sulfamethoxazole (TMP-SMX) for 7 weeks did not improve the clinical manifestation, even though in vitro susceptibility testing of the isolate predicted its susceptibility to MINO and TMP-SMX. Treatment with partial surgical excision followed by TMP-SMX and meropenem administration was effective. This is the first reported case of a lymphocutaneous type of nocardiosis caused by N. vinacea.

Identification of Nocardia farcinica by a PCR primer amplifying a specific DNA band for the bacterium

A PCR primer specific to Nocardia farcinica was prepared based on sequence information of random amplified polymorphic DNA (RAPD) analysis. The PCR primer amplifies N. farcinica species only; no amplification was observed in 25 other Nocardia strains that we tested. Specificity of the primer for N. farcinica was also confirmed using other fungal and bacterial strains that are frequently isolated from clinical samples such as sputa and broncho alveolar lavage (VAL).

Taxonomy and Phylogenetic Analysis of Infectious Nocardia Strains Isolated from Clinical Samples

Following recent advances in medical technology, the increased number of immunocompromised patients such as those with organ transplants has led to an increase in opportunistic infections due to Nocardia. Although nocardiosis has been considered to be rare, recent reports indicate that the incidence of the infection is increasing. The Nocardia asteroides group is the principal source of infectious species, but the definition of species in Nocardia is problematic because species identification of N. asteroides has been based on mainly morphological and biochemical properties. Additionally, it was assumed that a clinical strain with properties that did not fully coincide with existing species was N. asteroides sensu lato. This caused problems in both clinical and taxonomical fields, and reclassification of N. asteroides sensu lato was necessary. Therefore, determination of the appropriate taxonomic position of N. asteroides sensu lato that is now classified as N. asteroides sensu stricto was conducted using a molecular phylogenetic method. From 1965 to 2001, twenty-two strains of N. asteroides sensu lato were isolated from clinical samples. The phylogenetic tree using 16S rDNA sequences and detailed biochemical characters on the 22 isolates was determined. Results revealed that nine strains should be reclassified into species other than N. asteroides sensu stricto, and we proposed nine new species of the genus Nocardia. In addition, we proposed eight other new species of the genus Nocardia from other samples; hence seventeen new species were proposed in total. We also reported the first infectious cases due to Nocardia beijingensis, Nocardia transvalensis and Nocardia pseudobrasiliensis in Japan.

Nocardia exalbida sp. nov., isolated from Japanese patients with nocardiosis

Two bacterial strains isolated from different hospitals in Japan were subjected to a polyphasic analysis. Strains IFM 0803T and IFM 10383 were found to have morphological, biochemical, physiological and chemotaxonomic properties consistent with their classification in the genus Nocardia. Strains IFM 0803T and IFM 10383 clustered with the type strain of Nocardia xishanensis, showing 16S rRNA gene sequence similarities of 98.6–98.9 % with this species. The novel strains could be distinguished from N. xishanensis by a range of phenotypic properties. Based on their phenotypic and phylogenetic characteristics, the two isolates are proposed as members of a novel species of the genus Nocardia, Nocardia exalbida sp. nov., with the type strain IFM 0803T (=NBRC 100660T=JCM 12667T=DSM 44883T).

Outbreak of Nocardia farcinica infection with the same pattern in randomly amplified polymorphic DNA analysis

We experienced three cases of nocardiosis by Nocardia farcinica in the same ward within a six-month period. The result of gene analysis by randomly amplified polymorphic DNA gave the same pattern. Thus, these three cases were considered to be caused by the same strain of N. farcinica, implying the presence of nosocomial infection.

Nocardia cyriacigeorgica is a significant pathogen responsible for nocardiosis in Japan and Thailand

Nocardia cyriacigeorgica is a recently described species. During routine diagnostic testing of 121 clinical isolates, we found that about one fourth of the strains from Japan (19 isolates) and Thailand (8 isolates), which were identified in our laboratories as N. asteroides, in fact belong to N. cyriacigeorgica. To our knowledge, this is the first report of infection due to N. cyriacigeorgica in Japan and Thailand, and the third report of infection anywhere in the world. Although N. cyriacigeorgica is usually differentiated from other Nocardia species by utilization of glucose and gluconate, we found that it can also be differentiated by a characteristic synergistic effect between imipenem (IPM) and tobramycin (TOB).

Nocardiosis en pacientes infectados por el VIH

BACKGROUND

Nocardiosis is a bacterial disease that occurs in immunocompromised patients, including those infected by the human immunodeficiency virus (HIV).

METHODS

We retrospectively analyzed the clinical records of 27 HIV-positive patients with nocardiosis seen during the period of 1993 to 2004. Clinical presentations, diagnostic methods, predominant species, antimicrobial therapy and outcome were analyzed.

RESULTS

Among the total, 81% were males and the median age was 30 years. There was an elevated percentage of alcoholism (89%), smoking (80%) and intravenous drug use (82%). A previous positive serology for HIV infection was present in 85% of the patients. Plasma CD4+ T cell count at the time of diagnosis in 15 of 17 patients (88%) was below 50 cells/microl (median 15 cells/microl). The most frequent clinical onset was pulmonary in 70%, followed by cutaneous in 11% and disseminated in 11%. The main specimens for diagnostic bacterial isolation were sputum (54%), skin and soft tissues (22%) and bronchoalveolar lavage (19%). The predominant pulmonary radiological pattern was alveolar infiltration (74%), followed by cavitations (32%). The species was identified in 13 patients (48%); Nocardia asteroides was isolated in 84% (n = 11). The main antimicrobial drugs prescribed were cotrimoxazole (78%), amikacin (59%) and ciprofloxacin (33%). Dual therapy was used in 78% of the cases, with cotrimoxazole-amikacin being the most frequent. Overall mortality was 37%.

CONCLUSIONS

Nocardiosis is an unusual infection among HIV-infected patients. The diagnosis should be considered in patients with CD4+ T cell counts below 50/microL and lung or pericardial involvement.

Nocardia shimofusensis sp. nov., isolated from soil, and Nocardia higoensis sp. nov., isolated from a patient with lung nocardiosis in Japan

Three actinomycete strains isolated from soils and one strain isolated from a patient with lung nocardiosis in 1999 and 2001 in Japan have been provisionally assigned to the genus Nocardia on the basis of morphological criteria. These isolates were further investigated to determine their specific taxonomic status. Detailed chemotaxonomic characterization and 16S rRNA gene sequence analysis of these isolates confirmed that they belong to the genus Nocardia. The 16S rRNA gene sequences of the four strains were most similar to that of Nocardia farcinica. However, the sequence similarity values between these four strains and N. farcinica were <98.9 %. These four strains were susceptible to 5-fluorouracil, and they have the ability to decompose urea, which is a very characteristic trait. Furthermore, DNA-DNA relatedness data revealed that IFM 10311(T), IFM 10312 and IFM 10313 comprise a single novel species of Nocardia, that IFM 10084(T) represents another novel species of Nocardia and that these two novel species could be distinguished from N. farcinica. The names Nocardia shimofusensis sp. nov. and Nocardia higoensis sp. nov. are proposed, with IFM 10311(T) (=NBRC 100134(T)=JCM 12122(T)=DSM 44733(T)) and IFM 10084(T) (=NBRC 100133(T)=JCM 12121(T)=DSM 44732(T)) as the respective type strains.

Nocardia araoensis sp. nov. and Nocardia pneumoniae sp. nov., isolated from patients in Japan

Two actinomycete strains isolated from two patients with lung nocardiosis between 1995 and 1997 in Japan were assigned to novel species of the genus Nocardia based on morphological and chemical criteria. Comparative 16S rRNA gene sequence analysis of the two strains revealed that they belong to the genus Nocardia and are most closely related to the species Nocardia beijingensis. Determination of DNA-DNA relatedness indicated that these strains could be assigned to two novel species. Based on their phenotypic and phylogenetic characters, two novel species of the genus Nocardia are proposed: Nocardia araoensis sp. nov. for IFM 0575(T) (=NBRC 100135(T)=JCM 12118(T)=DSM 44729(T)) and Nocardia pneumoniae sp. nov. for IFM 0784(T) (=NBRC 100136(T)=JCM 12119(T)=DSM 44730(T)).

Characterization of clinical isolates of pathogenic Nocardia strains and related actinomycetes in Thailand from 1996 to 2003

In Thailand from 1996 to 2003, 171 strains of pathogenic aerobic actinomycetes from clinical specimens were isolated. Of those strains, 134 were mycolic acid containing actinomycetes, including 96 strains of Nocardia species. Others included 10 strains of Gordonia, 14 strains of Rhodococcus, and 22 strains of Mycobacterium. One strain each of the genera Tsukamurella and Corynebacterium were also isolated. Also identified were 27 strains of non-mycolic acid containing actinomycetes. Our identification studies of 96 strains of Nocardia species showed that significant pathogens in Thailand were N. beijingensis (18 strains), N. cyriacigeorgica (13 strains), and N. farcinica (34 strains); the most prevalent species was N. farcinica (35.4%). We also isolated four strains of N. asiatica, five strains of N. asteroides sensu stricto, four strains of N. nova, seven strains of N. otitidiscaviarum, eight strains of N. transvalensis, and two strains of N. pseudobrasiliensis.

Nocardia aobensis Sp. Nov., isolated from patients in Japan

Five clinical isolates, strains IFM 0137, 0372(T), 0496, 0556, and 0952, were provisionally assigned to the genus Nocardia based on morphological criteria. Nearly complete 16S rDNA sequences were determined for these strains. These data showed that they are most similar to that of Nocardia africana, Nocardia cerradoensis and Nocardia veterana. However, DNA-DNA relatedness data showed that the five strains were of a single species and were distinguishable from N. africana, N. cerradoensis and N. veterana. Therefore, these strains represent a new species within the genus Nocardia. The designation of these five strains is Nocardia aobensis sp. nov. The type strain is IFM 0372(T) (=NBRC 100429(T)=JCM 12352(T)=DSM 44805(T)).

Nocardia testaceus sp. nov. and Nocardia senatus sp. nov., isolated from patients in Japan

Two actinomycete strains isolated from sputum between 1999 and 2001 in Japan were provisionally assigned to the genus Nocardia based on morphological criteria. These isolates were further studied in order to determine their specific taxonomic status. Detailed chemotaxonomic characterization and 16S rDNA gene sequence analysis of these isolates also confirmed that they belong to the genus Nocardia. The 16S rDNA sequence data of the two strains showed that they are most similar to that of Nocardia carnea and Nocardia flavorosea. However, DNA-DNA relatedness data showed that the two strains could be distinguished from N. carnea and N. flavorosea and therefore represented two new species within the genus Nocardia. The designation of the two isolated strains are Nocardia testaceus for IFM 0937(T) (=JCM 12235(T), DSM 44765(T)) and Nocardia senatus for IFM 10088(T) (=JCM 12236(T), DSM 44766(T)).

Nocardia arthritidis sp. nov., a new pathogen isolated from a patient with rheumatoid arthritis in Japan

Two different bacterial strains with different drug susceptibilities were isolated from the sputum and an inflammatory discharge from a swelling in the left thigh of a patient with rheumatoid arthritis. Both bacterial strains were provisionally assigned to the genus Nocardia on the basis of their morphological and chemotaxonomic characteristics and were further studied in order to establish their taxonomic status. One strain (IFM 10034) was identified as Nocardia farcinica on the basis of its physiological characteristics. The other strain, which was designated Nocardia sp. strain IFM 10035(T), revealed a unique pattern of phenotypic properties that distinguished it from other representatives of established Nocardia species. Comparative 16S rRNA gene sequence studies of Nocardia sp. strain IFM 10035(T) also showed that the bacterium was closely related to the species Nocardia beijingensis. Determination of DNA-DNA relatedness, however, indicated that Nocardia sp. strain IFM 10035(T) could be delineated from N. beijingensis. The genotypic and phenotypic data combined indicated that the bacterium merits description as a new Nocardia species. The name proposed for the new species is Nocardia arthritidis sp. nov., the type strain being IFM 10035(T) (NBRC 100137(T), JCM 12120(T), DSM44731(T)). The present study suggests that Nocardia infections can be caused by multiple species of the bacterium.

Nocardia inohanensis sp. nov., Nocardia yamanashiensis sp. nov. and Nocardia niigatensis sp. nov., isolated from clinical specimens

Comparative 16S rDNA studies on six strains of actinomycete isolated from clinical specimens revealed that they belong to the genus Nocardia and are closely related to Nocardia seriolae, Nocardia otitidiscaviarum, Nocardia uniformis, Nocardia pseudobrasiliensis and Nocardia crassostreae. However, the novel organisms consistently formed a clade distinct from that of the five latter species. Determination of DNA-DNA relatedness indicated that these strains could be classified under three novel species. Based on their phenotypic and phylogenetic characters, three novel species of the genus Nocardia are established: Nocardia inohanensis sp. nov. for IFM 0092(T) (=NBRC 100128(T)=JCM 11891(T)=DSM 44667(T)), Nocardia yamanashiensis sp. nov. for IFM 0265(T) (=NBRC 100130(T)=JCM 11893(T)=DSM 44669(T)) and Nocardia niigatensis sp. nov. for IFM 0330(T) (=NBRC 100131(T)=JCM 11894(T)=DSM 44670(T)), IFM 0260, IFM 0636 and IFM 0833.

Nocardia beijingensis, is a pathogenic bacterium to humans: the first infectious cases in Thailand and Japan

Nocardia beijingensis, a recently established new species, is an isolate from soil in China. During our taxonomic studies on 450 nocardial clinical isolates in Thailand and Japan, 17 strains from Thailand and 1 strain from Japan were found to have a similar physiological characteristic to those of N. beijingensis, such as a drug susceptibility pattern to three antimicrobial agents. Our phylogenetic studies on these 18 strains by 16S rRNA gene sequence analysis confirmed that these strains belong to N. beijingensis species. Phylogenetically, these newly isolated N. beijingensis strains were found to be classified into two distinct clades: one is a Japanese clade and other is a Chinese clade, including a reference strain and 17 Thai strains. This is the first report of human infection due to N. beijingensis strains, and we propose that the bacterium be categorized as an opportunistic infectious group regardless of its original isolation from soil.

Nocardia asiatica sp. nov., isolated from patients with nocardiosis in Japan and clinical specimens from Thailand

Five strains isolated from two patients with nocardiosis in Japan and three clinical samples from Thailand were found to have morphological, biochemical and chemotaxonomic properties consistent with their classification in the genus Nocardia. DNA-DNA hybridization, coupled with sequence analysis of 16S rDNA, indicated that these strains belong to a novel species of the genus Nocardia, named Nocardia asiatica sp. nov. because the isolation sites were in Asian countries; the type strain is IFM 0245T (=NBRC 100129T=JCM 11892T=DSM 44668T).

First human case of nocardiosis caused by Nocardia pseudobrasiliensis in Japan

Nocardia sp. IFM 0896, an actinomycete with biochemical characteristics that differed from Nocardia brasiliensis, was isolated from a 71-year-old Japanese man with a history of tuberculosis and cancer. Although the isolate was tentatively identified as N. brasiliensis, the morphological and physiological characteristics of strain IFM 0896 were different from those of N. brasiliensis IFM 0236T. The results of 16S rRNA gene sequence phylogenies and PCR-RFLP analysis of a heat shock protein revealed that Nocardia sp. IFM 0896 belongs to the species N. pseudobrasiliensis. This is the first clinical isolation report of N. pseudobrasiliensis in Japan.

Nocardia africana sp. nov., a new pathogen isolated from patients with pulmonary infections

Eight actinomycete strains, isolated from 8 out of 400 sputum samples examined, taken from patients with pulmonary diseases at the Chest Unit of Khartoum Teaching Hospital in the Sudan, were provisionally assigned to the genus Nocardia according to morphological criteria. These isolates were studied further in order to establish their taxonomic status. They were found to have morphological and chemical properties typical of nocardiae and formed a monophyletic clade in the 16S ribosomal DNA tree together with Nocardia vaccinii. The strains showed a unique pattern of phenotypic properties that distinguished them from representatives of recognized Nocardia species, including Nocardia vaccinii. The strains were considered to merit species status and were designated Nocardia africana sp. nov. The findings of the present study are consistent with the view that pulmonary nocardiosis may occur in a substantial proportion of patients who exhibit chronic lung diseases in African countries. It is important, therefore, that clinicians in such countries consider this condition, especially when patients with respiratory infections fail to respond to antitubercular therapy.