Nocardia

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Nocardia
Nocardia species close-up detail.jpg
Close-up image of a Nocardia species culture on sheep blood agar
Scientific classification OOjs UI icon edit-ltr.svg
Domain: Bacteria
Phylum: Actinomycetota
Class: Actinomycetia
Order: Mycobacteriales
Family: Nocardiaceae
Genus: Nocardia
Trevisan 1889 (Approved Lists 1980)
Type species
Nocardia asteroides
(Eppinger 1891) Blanchard 1896 (Approved Lists 1980)
Species

See text.

Synonyms [1]
  • MicropolysporaLechevalier et al. 1961 (Approved Lists 1980)
  • AsteroidesPuntoni & Leonardi, 1935
  • Proactinomyces(K.Lehmann & Haag) H.L.Jensen, 1934 [2]
Nocardia as found on a brain biopsy. Nocardia Brain Autopsy.jpg
Nocardia as found on a brain biopsy.

Nocardia is a genus of weakly staining Gram-positive, catalase-positive, rod-shaped bacteria. It forms partially acid-fast beaded branching filaments (appearing similar to fungi, but being truly bacteria). It contains a total of 85 species. Some species are nonpathogenic, while others are responsible for nocardiosis. [3] Nocardia species are found worldwide in soil rich in organic matter. In addition, they are oral microflora found in healthy human gingiva, as well as periodontal pockets. [4] Most Nocardia infections are acquired by inhalation of the bacteria or through traumatic introduction through openings in epithelial barriers.

Contents

Culture and staining

Nocardia colonies have a variable appearance, but most species appear to have aerial hyphae when viewed with a dissecting microscope, particularly when they have been grown on nutritionally limiting media. Nocardia grow slowly on nonselective culture media, and are strict aerobes with the ability to grow in a wide temperature range. Some species are partially acid-fast (meaning a less concentrated solution of sulfuric or hydrochloric acid should be used during the staining procedure) due to the presence of intermediate-length mycolic acids in their cell wall. Majority of strains possess the cord factor (trehalose 6-6' dimycolate), an important virulence factor.

Four different Nocardia species on sheep blood agar demonstrating different colouring Four different Nocardia species.jpg
Four different Nocardia species on sheep blood agar demonstrating different colouring

They are catalase positive and can grow easily on the most commonly used media with colonies becoming evident in 3–5 days. However, prolonged incubation periods (2–3 weeks) are sometimes needed.

Nocardia asteroides Nocardia asteroides.png
Nocardia asteroides

Virulence

The various species of Nocardia are pathogenic bacteria with low virulence; therefore clinically significant disease most frequently occurs as an opportunistic infection in those with a weak immune system, such as small children, the elderly, and the immunocompromised (most typically, HIV). Nocardial virulence factors are the enzymes catalase and superoxide dismutase (which inactivate reactive oxygen species that would otherwise prove toxic to the bacteria), as well as a "cord factor" (which interferes with phagocytosis by macrophages by preventing the fusion of the phagosome with the lysosome).[ citation needed ]

An important virulence factor in many pathogenic strains of Nocardia is trehalose dimycolate, which is also found in the bacterial genus Mycobacterium . This toxin can cause cachexia, a form of muscle wasting. [5]

Clinical disease and microbiological diagnosis

The most commonly encountered species are Nocardia brasiliensis, Nocardia cyriacigeorgica, Nocardia farcinica, and Nocardia nova. Nocardia asteroides is most frequently found species causing noncutaneous invasive disease. Most cases occur as an opportunistic infection in immunocompromised patients. N. brasiliensis is the most common species causing cutaneous nocardiosis. N. caviae is another species of medical interest. The genus is acid-fast to some degree, it stains only weakly Gram positive.

The most common form of human nocardial disease is a slowly progressive pneumonia, the common symptoms of which include cough, dyspnea (shortness of breath), and fever. It is not uncommon for this infection to spread to the pleura or chest wall. Pre-existing pulmonary disease, especially pulmonary alveolar proteinosis, increases the risk of contracting a Nocardia pneumonia. Every organ can be affected if a systemic spread takes place.

Nocardia species are deeply involved in the process of encephalitis as one of its main pathogenic effects. In about 25–33% of people Nocardia infection takes the form of encephalitis and/or brain abscess formation. Nocardia may also cause a variety of cutaneous infections such as actinomycetoma (especially N. brasiliensis), lymphocutaneous disease, cellulitis, and subcutaneous abscesses. [6]

Nocardia isolation from biological specimens can be performed using an agar medium enriched with yeast extract and activated charcoal (BCYE), the same used for Legionella species. Selective media for mycobacteria or fungi can also be inoculated. The most suitable specimens are the sputum, or when clinically necessary, bronchoalveolar lavage or biopsy. Further biochemical tests for species identification are not routinely performed. Serological or cutaneous tests are not available.

Treatment

In most patients with Nocardia infection, the combination of antibiotics is needed. [7] Antibiotic therapy with a sulfonamide, most commonly trimethoprim-sulfamethoxazole, is the treatment of choice. [8] People who take trimethoprim-sulfamethoxazole for other reasons, such as prevention of Pneumocystis jirovecii infection, appear to have fewer Nocardia infections, [9] although this protective effect has been considered unreliable, [10] and some studies have disputed it altogether. [11] Minocycline is usually substituted when a sulfa cannot be given; high-dose imipenem and amikacin have also been used in severe or refractory cases. [8] Linezolid appears to be highly effective against Nocardia, but it is very expensive and may cause severe adverse effects. [12]

Antibiotic therapy is continued for six months (in immunocompetent people) to a year (in immunosuppression), and may need to be continued indefinitely. [8] Proper wound care is also critical.

Genetics

Although Nocardia has interesting and important features such as production of antibiotics and aromatic compound-degrading or -converting enzymes, the genetic study of this organism has been hampered by the lack of genetic tools. However, practical NocardiaE. coli shuttle vectors have been developed recently. [13]

The genera Nocardia and Rhodococcus have been found to be closely related, supported by two conserved signature indels consisting of a one-amino-acid deletion in the alpha subunit of acetyl coenzyme A carboxylase (ACC), and a three-amino-acid insertion in a conserved region of an ATP-binding protein that are specifically shared by species from these two genera. In addition, 14 hypothetical conserved signature proteins have been identified which are unique to the genera Nocardia and Rhodococcus. [14]

Species

Nocardia comprises the following species: [1]

Nomenclature

The genus was named for Edmond Nocard (1850-1903), a French 19th-century veterinarian and biologist. [15]

The genus was circumscribed by Vittore Benedetto Antonio Trevisan di Saint-Léon in Ann. Inst. Pasteur vol.2 (Issue 6) on page 295 in 1888. [2]

Related Research Articles

<i>Mycoplasma</i> Genus of bacteria

Mycoplasma is a genus of bacteria that, like the other members of the class Mollicutes, lack a cell wall, and its peptidoglycan, around their cell membrane. The absence of peptidoglycan makes them naturally resistant to antibiotics such as the beta-lactam antibiotics that target cell wall synthesis. They can be parasitic or saprotrophic. Several species are pathogenic in humans, including M. pneumoniae, which is an important cause of "walking" pneumonia and other respiratory disorders, and M. genitalium, which is believed to be involved in pelvic inflammatory diseases. Mycoplasma species are among the smallest organisms yet discovered, can survive without oxygen, and come in various shapes. For example, M. genitalium is flask-shaped, while M. pneumoniae is more elongated, many Mycoplasma species are coccoid. Hundreds of Mycoplasma species infect animals.

<i>Pseudomonas</i> Genus of Gram-negative bacteria

Pseudomonas is a genus of Gram-negative bacteria belonging to the family Pseudomonadaceae in the class Gammaproteobacteria. The 313 members of the genus demonstrate a great deal of metabolic diversity and consequently are able to colonize a wide range of niches. Their ease of culture in vitro and availability of an increasing number of Pseudomonas strain genome sequences has made the genus an excellent focus for scientific research; the best studied species include P. aeruginosa in its role as an opportunistic human pathogen, the plant pathogen P. syringae, the soil bacterium P. putida, and the plant growth-promoting P. fluorescens, P. lini, P. migulae, and P. graminis.

<i>Mycobacterium</i> Genus of bacteria

Mycobacterium is a genus of over 190 species in the phylum Actinomycetota, assigned its own family, Mycobacteriaceae. This genus includes pathogens known to cause serious diseases in mammals, including tuberculosis and leprosy in humans. The Greek prefix myco- means 'fungus', alluding to this genus' mold-like colony surfaces. Since this genus has cell walls with a waxy lipid-rich outer layer that contains high concentrations of mycolic acid, acid-fast staining is used to emphasize their resistance to acids, compared to other cell types.

<i>Listeria monocytogenes</i> Species of pathogenic bacteria that causes the infection listeriosis

Listeria monocytogenes is the species of pathogenic bacteria that causes the infection listeriosis. It is a facultative anaerobic bacterium, capable of surviving in the presence or absence of oxygen. It can grow and reproduce inside the host's cells and is one of the most virulent foodborne pathogens. Twenty to thirty percent of foodborne listeriosis infections in high-risk individuals may be fatal. In the European Union, listeriosis continues an upward trend that began in 2008, causing 2,161 confirmed cases and 210 reported deaths in 2014, 16% more than in 2013. In the EU, listeriosis mortality rates also are higher than those of other foodborne pathogens. Responsible for an estimated 1,600 illnesses and 260 deaths in the United States annually, listeriosis ranks third in total number of deaths among foodborne bacterial pathogens, with fatality rates exceeding even Salmonella spp. and Clostridium botulinum.

<i>Micromonospora</i> Genus of bacteria

Micromonospora is a genus of bacteria of the family Micromonosporaceae. The genus name was first proposed in 1923 by Danish physician Jeppe Ørskov in an attempt to classify what at the time was considered "ray fungi" based on morphology. Members of this genus are found throughout natural soil and sediment environments, as well as in association with roots of plants of various species. The genus is well known for its ability to produce a variety of medically relevant products.

Nocardiosis is an infectious disease affecting either the lungs or the whole body. It is due to infection by a bacterium of the genus Nocardia, most commonly Nocardia asteroides or Nocardia brasiliensis.

<i>Actinomyces</i> Genus of bacteria

Actinomyces is a genus of the Actinomycetia class of bacteria. They all are gram-positive and facultatively anaerobic, growing best under anaerobic conditions. Actinomyces species may form endospores, and while individual bacteria are rod-shaped, Actinomyces colonies form fungus-like branched networks of hyphae. The aspect of these colonies initially led to the incorrect assumption that the organism was a fungus and to the name Actinomyces, "ray fungus".

<i>Corynebacterium</i> Genus of bacteria

Corynebacterium is a genus of Gram-positive bacteria and most are aerobic. They are bacilli (rod-shaped), and in some phases of life they are, more specifically, club-shaped, which inspired the genus name.

<i>Aspergillus fumigatus</i> Species of fungus

Aspergillus fumigatus is a species of fungus in the genus Aspergillus, and is one of the most common Aspergillus species to cause disease in individuals with an immunodeficiency.

<i>Staphylococcus haemolyticus</i> Species of bacterium

Staphylococcus haemolyticus is a member of the coagulase-negative staphylococci (CoNS). It is part of the skin flora of humans, and its largest populations are usually found at the axillae, perineum, and inguinal areas. S. haemolyticus also colonizes primates and domestic animals. It is a well-known opportunistic pathogen, and is the second-most frequently isolated CoNS. Infections can be localized or systemic, and are often associated with the insertion of medical devices. The highly antibiotic-resistant phenotype and ability to form biofilms make S. haemolyticus a difficult pathogen to treat. Its most closely related species is Staphylococcus borealis.

The Actinomycetaceae are a family of bacteria in the order Actinomycetales that contains the medically important genus Actinomyces. These organisms are closely related to the mycobacteria, but were originally classified as fungi because they were thought to be transitional forms between bacteria and fungi.

Nocardia brasiliensis is a species of Nocardia. As with most members of Actinomycetota, they contain high guanine and cytosine content. It can cause nocardiosis.

<i>Rhodococcus equi</i> Species of bacterium

Rhodococcus equi is a Gram-positive coccobacillus bacterium. The organism is commonly found in dry and dusty soil and can be important for diseases of domesticated animals. The frequency of infection can reach near 60%. R. equi is an important pathogen causing pneumonia in foals. Since 2008, R. equi has been known to infect wild boar and domestic pigs. R. equi can infect immunocompromised people, such as HIV-AIDS patients or organ transplant recipients. Rhodococcus equi infection in these populations resemble the clinical and pathological signs of advanced pulmonary tuberculosis. This organism is a facultative intracellular mycobacterial pathogen.

<span class="mw-page-title-main">Pseudonocardiaceae</span> Family of bacteria

The Pseudonocardiaceae are a family of bacteria in the order Actinomycetales and the only member of the suborder Pseudonocardineae.

<span class="mw-page-title-main">Cord factor</span> Chemical compound

Cord factor, or trehalose dimycolate (TDM), is a glycolipid molecule found in the cell wall of Mycobacterium tuberculosis and similar species. It is the primary lipid found on the exterior of M. tuberculosis cells. Cord factor influences the arrangement of M. tuberculosis cells into long and slender formations, giving its name. Cord factor is virulent towards mammalian cells and critical for survival of M. tuberculosis in hosts, but not outside of hosts. Cord factor has been observed to influence immune responses, induce the formation of granulomas, and inhibit tumor growth. The antimycobacterial drug SQ109 is thought to inhibit TDM production levels and in this way disrupts its cell wall assembly.

<i>Bifidobacterium</i> Genus of bacteria

Bifidobacterium is a genus of gram-positive, nonmotile, often branched anaerobic bacteria. They are ubiquitous inhabitants of the gastrointestinal tract though strains have been isolated from the vagina and mouth of mammals, including humans. Bifidobacteria are one of the major genera of bacteria that make up the gastrointestinal tract microbiota in mammals. Some bifidobacteria are used as probiotics.

Nocardia farcinica is a species of bacteria, once thought to be associated with farcy, and a member of the genus Nocardia. This species is very similar in phenotype to Nocardia asteroides, to the degree that some isolates of N. asteroides were later found to be Nocardia farcinica.

Nocardia ignorata is a species of bacteria and a member of the genus Nocardia. Its type strain is IMMIB R-1434T.

Gordonia is a genus of gram-positive, aerobic, catalase-positive bacterium in the Actinomycetota, closely related to the Rhodococcus, Mycobacterium, Skermania, and Nocardia genera. Gordonia bacteria are aerobic, non-motile, and non-sporulating. Gordonia is from the same lineage that includes Mycobacterium tuberculosis. The genus was discovered by Tsukamura in 1971 and named after American bacteriologist Ruth Gordon. Many species are often found in the soil, while other species have been isolated from aquatic environments. Some species have been associated with problems like sludge bulking and foaming in wastewater treatment plants. Gordonia species are rarely known to cause infections in humans.

<i>Clostridioides difficile</i> Species of bacteria

Clostridioides difficile is a bacterium known for causing serious diarrheal infections, and may also cause colon cancer. It is known also as C. difficile, or C. diff, and is a Gram-positive species of spore-forming bacteria. Clostridioides spp. are anaerobic, motile bacteria, ubiquitous in nature and especially prevalent in soil. Its vegetative cells are rod-shaped, pleomorphic, and occur in pairs or short chains. Under the microscope, they appear as long, irregular cells with a bulge at their terminal ends. Under Gram staining, C. difficile cells are Gram-positive and show optimum growth on blood agar at human body temperatures in the absence of oxygen. C. difficile is catalase- and superoxide dismutase-negative, and produces up to three types of toxins: enterotoxin A, cytotoxin B and Clostridioides difficile transferase. Under stress conditions, the bacteria produce spores that are able to tolerate extreme conditions that the active bacteria cannot tolerate.

References

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Further reading