[Nocardia cyriacigeorgici: First report of invasive human infection].
BACKGROUND
Diagnostic laboratories increasingly offer bacterial identification to the species level. The 17 nocardia species known to date differ in their clinical presentation, antibiotic resistance patterns and geographic distribution. The discovery of a new species with pathogenicity for humans calls for the characterization of its clinical and epidemiological properties.


METHODS
Nocardia isolated from multifocal brain abscesses of an immunocompromised patient were further identified by the analysis of their cellular fatty acids and sequencing of the 16S ribosomal DNA. Quantitative antibiotic resistance testing was performed with E-tests.


RESULTS
The 16S ribosomal DNA analysis showed a 99 % homology to Nocardia cyriacigeorgici. This is the first report of this species as an invasive human pathogen. N. cyriacigeorgici was found susceptible for meropenem, amikacin, ceftriaxon and cotrimoxazole. The combination of surgical drainage and antibiotic treatment for 13 months was curative.


CONCLUSIONS
N. cyriacigeorgici has the potential to cause invasive infections at least in immunocompromised patients. Comparing clinical and in vitro characteristics with N. asteroides, the main causative agent of nocardial infections in Europe, we found no clinically relevant differences.
Institut für Infektionskrankheiten, Universität Bern.
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D000583:Amikacin / Q000494:pharmacology / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001922:Brain Abscess / Q000382:microbiology* / Q000601:surgery; D002443:Ceftriaxone / Q000494:pharmacology / Q000627:therapeutic use; D004275:DNA, Ribosomal / Q000737:chemistry; D004322:Drainage; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D000077731:Meropenem; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009615:Nocardia / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D009617:Nocardia Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D012689:Sequence Homology, Nucleic Acid; D013845:Thienamycins / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D004275:DNA, Ribosomal; D012336:RNA, Ribosomal, 16S; D013845:Thienamycins; D002443:Ceftriaxone; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000583:Amikacin; D000077731:Meropenem