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Jiao M, Deng X, Yang H, Dong J, Lv J, Li F. Case Report: A Severe and Multi-Site Nocardia farcinica Infection Rapidly and Precisely Identified by Metagenomic Next-Generation Sequencing. Front Med (Lausanne) 2021; 8:669552. [PMID: 34109198 PMCID: PMC8183679 DOI: 10.3389/fmed.2021.669552] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/29/2021] [Indexed: 01/29/2023] Open
Abstract
Nocardia genus is an aerobic, gram-positive, and opportunistic pathogen, which mainly affects cell-mediated immunosuppressed patients. Early diagnosis and treatment greatly improve prognosis. However, the limitation of golden standard-bacterial culture exists. Here, we report a 61-year-old male with pneumonia, sepsis and intermuscular abscesses induced by Nocardia farcinica. Venous blood culture reported negative results. Former improper diagnosis and treatment did not improve his condition. With the assistant of metagenomic next-generation sequencing, the pathogen was identified as Nocardia farcinica. He was then applied with accurate treatment and had a remarkable clinical and radiological improvement.
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Affiliation(s)
- Mengfan Jiao
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Precision Medicine Center, Gene Hospital of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiang Deng
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongfu Yang
- Department of Integrated Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junqiang Dong
- Department of Imaging and Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Lv
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fang Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Baio PVP, Ramos JN, dos Santos LS, Soriano MF, Ladeira EM, Souza MC, Camello TCF, Ribeiro MG, Hirata Junior R, Vieira VV, Mattos-Guaraldi AL. Molecular identification of nocardia isolates from clinical samples and an overview of human nocardiosis in Brazil. PLoS Negl Trop Dis 2013; 7:e2573. [PMID: 24340116 PMCID: PMC3854972 DOI: 10.1371/journal.pntd.0002573] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 10/21/2013] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Paulo Victor Pereira Baio
- Universidade do Estado do Rio de Janeiro – UERJ, Faculdade de Ciências Médicas, Departamento de Microbiologia, Imunologia e Patologia, Laboratório de Difteria e Corinebactérias de Importância Clínica-LDCIC, Centro Colaborador para Difteria da CGLAB/SVS/MS, Rio de Janeiro, Rio de Janeiro, Brazil
- Fundação Oswaldo Cruz, Instituto Nacional de Controle de Qualidade em Saúde (INCQS), Instituto Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
- Ministério da Defesa, Laboratório Químico Farmacêutico do Exército, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Juliana Nunes Ramos
- Universidade do Estado do Rio de Janeiro – UERJ, Faculdade de Ciências Médicas, Departamento de Microbiologia, Imunologia e Patologia, Laboratório de Difteria e Corinebactérias de Importância Clínica-LDCIC, Centro Colaborador para Difteria da CGLAB/SVS/MS, Rio de Janeiro, Rio de Janeiro, Brazil
- Fundação Oswaldo Cruz, Instituto Nacional de Controle de Qualidade em Saúde (INCQS), Instituto Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Louisy Sanches dos Santos
- Universidade do Estado do Rio de Janeiro – UERJ, Faculdade de Ciências Médicas, Departamento de Microbiologia, Imunologia e Patologia, Laboratório de Difteria e Corinebactérias de Importância Clínica-LDCIC, Centro Colaborador para Difteria da CGLAB/SVS/MS, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Morgana Fonseca Soriano
- Universidade do Estado do Rio de Janeiro – UERJ, Faculdade de Ciências Médicas, Departamento de Microbiologia, Imunologia e Patologia, Laboratório de Difteria e Corinebactérias de Importância Clínica-LDCIC, Centro Colaborador para Difteria da CGLAB/SVS/MS, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elisa Martins Ladeira
- Fundação Oswaldo Cruz, Instituto Nacional de Controle de Qualidade em Saúde (INCQS), Instituto Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mônica Cristina Souza
- Universidade do Estado do Rio de Janeiro – UERJ, Faculdade de Ciências Médicas, Departamento de Microbiologia, Imunologia e Patologia, Laboratório de Difteria e Corinebactérias de Importância Clínica-LDCIC, Centro Colaborador para Difteria da CGLAB/SVS/MS, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thereza Cristina Ferreira Camello
- Universidade do Estado do Rio de Janeiro – UERJ, Faculdade de Ciências Médicas, Departamento de Microbiologia, Imunologia e Patologia, Laboratório de Difteria e Corinebactérias de Importância Clínica-LDCIC, Centro Colaborador para Difteria da CGLAB/SVS/MS, Rio de Janeiro, Rio de Janeiro, Brazil
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto, Laboratório de Bacteriologia, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcio Garcia Ribeiro
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina Veterinária e Zootecnia, Botucatu, São Paulo, Brazil
| | - Raphael Hirata Junior
- Universidade do Estado do Rio de Janeiro – UERJ, Faculdade de Ciências Médicas, Departamento de Microbiologia, Imunologia e Patologia, Laboratório de Difteria e Corinebactérias de Importância Clínica-LDCIC, Centro Colaborador para Difteria da CGLAB/SVS/MS, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Verônica Viana Vieira
- Fundação Oswaldo Cruz, Instituto Nacional de Controle de Qualidade em Saúde (INCQS), Instituto Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Luíza Mattos-Guaraldi
- Universidade do Estado do Rio de Janeiro – UERJ, Faculdade de Ciências Médicas, Departamento de Microbiologia, Imunologia e Patologia, Laboratório de Difteria e Corinebactérias de Importância Clínica-LDCIC, Centro Colaborador para Difteria da CGLAB/SVS/MS, Rio de Janeiro, Rio de Janeiro, Brazil
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Abstract
The recent explosion of newly described species of Nocardia results from the impact in the last decade of newer molecular technology, including PCR restriction enzyme analysis and 16S rRNA sequencing. These molecular techniques have revolutionized the identification of the nocardiae by providing rapid and accurate identification of recognized nocardiae and, at the same time, revealing new species and a number of yet-to-be-described species. There are currently more than 30 species of nocardiae of human clinical significance, with the majority of isolates being N. nova complex, N. abscessus, N. transvalensis complex, N. farcinica, N. asteroides type VI (N. cyriacigeorgica), and N. brasiliensis. These species cause a wide variety of diseases and have variable drug susceptibilities. Accurate identification often requires referral to a reference laboratory with molecular capabilities, as many newer species are genetically distinct from established species yet have few or no distinguishing phenotypic characteristics. Correct identification is important in deciding the clinical relevance of a species and in the clinical management and treatment of patients with nocardial disease. This review characterizes the currently known pathogenic species of Nocardia, including clinical disease, drug susceptibility, and methods of identification.
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Affiliation(s)
- Barbara A Brown-Elliott
- Department of Microbiology, The University of Texas Health Center, 11937 U.S. Highway 271, Tyler, 75708, USA
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