Molecular diagnosis of fatal Nocardia farcinica pneumonia in an HIV-negative patient

A 58-Year-Old Female with Progressive Cough and Right Shoulder Pain

Cavitary pneumonia in immunocompromised patients is a challenging entity. Establishing accurate diagnosis and starting effective antibiotics are essential steps towards improving outcome. A 58-year-old stem cell transplant patient was admitted to the hospital with necrotizing pneumonia caused by nocardia. The disease progressed despite of aggrieve antimicrobial therapy. Nocardiosis continues to be a difficult disease to diagnose and treat.

Nocardia - Opportunistic chest infection in elderly: A case report

In this rare case a non-immunocompromised patient with old Tuberculosis on low dose of steroids presents with opportunistic infection of a weakly aerobic gram positive acid fast, filamentous bacteria called Nocardia.An 80 year old non-smoking white female presented with cough, shortness of breath and purulent sputum.Initial antibiotics given were not helpful. Later microbial diagnosis was Nocardia in sputum sample which was uncommon in a non-immunocompromised. She responded to co-trimoxazole therapy.

Nocardia cyriacigeorgica, an emerging pathogen in the United States

Nocardia cyriacigeorgica is recognized as an emerging pathogen in many parts of the world. We present the first case description of invasive N. cyriacigeorgica pulmonary infection in the United States identified to the species level by 16S rRNA and hsp65 sequence analysis. A subsequent retrospective molecular screening of recent Nocardia clinical isolates at our New York City medical center yielded an additional six N. cyriacigeorgica isolates. Because routine laboratory algorithms for the phenotypic identification of Nocardia species are limited in practice, the true prevalence of N. cyriacigeorgica infections may be greater than currently appreciated. Indeed, we present evidence confirming that N. cyriacigeorgica is coincident with the unofficial species designation Nocardia asteroides complex antimicrobial susceptibility pattern type VI and distinct from the N. asteroides sensu stricto strain ATCC 19247(T). As nocardial species identity can predict antimicrobial susceptibility and guide clinical management, we offer simplified phenotypic and molecular protocols to assist the identification of N. cyriacigeorgica.