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Adv Biomed Res 2017,  6:49

Phenotypic and Molecular Identification of Nocardia in Brain Abscess

Department of Microbiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Date of Web Publication25-Apr-2017

Correspondence Address:
Mehdi Fatahi-Bafghi
Department of Microbiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2277-9175.205191

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How to cite this article:
Fatahi-Bafghi M. Phenotypic and Molecular Identification of Nocardia in Brain Abscess. Adv Biomed Res 2017;6:49

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Fatahi-Bafghi M. Phenotypic and Molecular Identification of Nocardia in Brain Abscess. Adv Biomed Res [serial online] 2017 [cited 2020 Jun 2];6:49. Available from:


Shirani et al. recently reported an article entitled, “Nocardial brain abscess in a patient with pulmonary alveolar proteinosis” (DOI: 10.4103/2277-9175.164004).[1] The genus Nocardia is a Gram-positive aerobic, partially acid-fast, and filamentous bacterium that causes nocardial infections (nocardiosis) in human. The genus Nocardia is normal microflora in the environment such as soil and dust.[2] Nocardiosis treatment is different in various species, and some species are resistant to different antibiotics such as trimethoprim-sulfamethoxazole, carbapenem, and aminoglycosides, as well as accurate identification in species level is important.

Attention to comments and questions:

  1. Isolation and characterization of morphology of colony, aerial hyphae, Gram stain, partially acid-fast, acid-fast, growth in lysozyme broth and molecular methods are important for the genus Nocardia confirmation.[2],[3],[4] Moreover, other aerobic actinomycetes such as Gordonia spp., Rhodococcus spp., and Tsukamurella spp. are Gram-positive, may be filamentous and colonial morphology are similar to each other.Gordonia spp., Rhodococcus spp., Tsukamurella spp., and Nocardia spp. are acid-fast in under certain conditions (bacteria listed are partially acid-fast and normally are not positive for acid-fast staining)[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12] while authors suggested that branching, filamentous, Gram-positive, and acid-fast positive elements are the genus Nocardia
  2. Authors reported Nocardia asteroides identification with culture and staining.[1] Phenotypic methods such as hydrolysis of amino acids, production of nitrate reductase, gelatinase, and urease, producing acid from carbohydrates, and growth at 45°C [2] are used in species level identification. I have two questions for authors:
    1. The genus Nocardia has some of complex groups such as N. asteroides complex (N. asteroides, Nocardia cyriacigeorgica, Nocardia farcinica, etc.,) and Nocardia nova complex.[2] Authors explain that how identified N. asteroides of other species in N. asteroides complex?
    2. The authors have not mentioned of the use of molecular techniques to Nocardia identification at species level in the article. The authors explain molecular method if used.
  3. In literature, although phenotypic methods are labor intensive and time-consuming, they are used in combination with molecular techniques such as polymerase chain reaction (PCR) sequencing (16S rRNA, hsp65, rpoB, gyrB, and secA genes) and PCR-restriction fragment length polymorphism for accurate identification in genus and species levels for Nocardia[2],[13]
  4. Drug choice for nocardiosis treatment is co-trimoxazole, but some of species are resistance to co-trimoxazole and other antibacterial agents; therefore, accurate identification in species level and antimicrobial susceptibility testing are important.[2],[14] Further, in literature, some of patients have hypersensitive reaction to co-trimoxazole.[15]

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  References Top

Shirani K, Poulsen AN, Hakamifard A. Nocardial brain abscess in a patient with pulmonary alveolar proteinosis. Adv Biomed Res 2015;4:185.  Back to cited text no. 1
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Brown-Elliott BA, Brown JM, Conville PS, Wallace RJ Jr. Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin Microbiol Rev 2006;19:259-82.  Back to cited text no. 2
Goodfellow M. Characterisation of Mycobacterium, Nocardia, Corynebacterium and related taxa. Ann Soc Belg Med Trop 1973;53:287-98.  Back to cited text no. 3
Goodfellow M, Lind A, Mordarska H, Pattyn S, Tsukamura M. A co-operative numerical analysis of cultures considered to belong to the 'rhodochrous' taxon. Microbiology 1974;85:291-302.  Back to cited text no. 4
Broughton RA, Wilson HD, Goodman NL, Hedrick JA. Septic arthritis and osteomyelitis caused by an organism of the genus Rhodococcus. J Clin Microbiol 1981;13:209-13.  Back to cited text no. 5
Severo LC, Petrillo VF, Coutinho LM. Actinomycetoma caused by Rhodococcus spp. Mycopathologia 1987;98:129-31.  Back to cited text no. 6
Arenskötter M, Bröker D, Steinbüchel A. Biology of the metabolically diverse genus Gordonia. Appl Environ Microbiol 2004;70:3195-204.  Back to cited text no. 7
Blanc V, Dalle M, Markarian A, Debunne MV, Duplay E, Rodriguez-Nava V, et al.Gordonia terrae: A difficult-to-diagnose emerging pathogen? J Clin Microbiol 2007;45:1076-7.  Back to cited text no. 8
Blaschke AJ, Bender J, Byington CL, Korgenski K, Daly J, Petti CA, et al.Gordonia species: Emerging pathogens in pediatric patients that are identified by 16S ribosomal RNA gene sequencing. Clin Infect Dis 2007;45:483-6.  Back to cited text no. 9
Prescott JF. Rhodococcus equi: An animal and human pathogen. Clin Microbiol Rev 1991;4:20-34.  Back to cited text no. 10
Goodfellow M, Alderson G. The actinomycete-genus Rhodococcus: A home for the 'rhodochrous' complex. Microbiology 1977;100:99-122.  Back to cited text no. 11
Liu CY, Lai CC, Lee MR, Lee YC, Huang YT, Liao CH, et al. Clinical characteristics of infections caused by Tsukamurella spp. and antimicrobial susceptibilities of the isolates. Int J Antimicrob Agents 2011;38:534-7.  Back to cited text no. 12
McTaggart LR, Richardson SE, Witkowska M, Zhang SX. Phylogeny and identification of Nocardia species on the basis of multilocus sequence analysis. J Clin Microbiol 2010;48:4525-33.  Back to cited text no. 13
Brown-Elliott BA, Biehle J, Conville PS, Cohen S, Saubolle M, Sussland D, et al. Sulfonamide resistance in isolates of Nocardia spp. from a US multicenter survey. J Clin Microbiol 2012;50:670-2.  Back to cited text no. 14
Walton N, Krumins D. Rapid desensitisation of an immunocompetent patient with cotrimoxazole hypersensitivity. J Pharm Pract Res 2010;40:130-2.  Back to cited text no. 15

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