title: First Case of Actinomycetoma in France Due to a NovelNocardiaSpecies,Nocardia boironiisp. nov.
abstract: Bacterial mycetoma is a neglected disease mainly observed in tropical area countries and typically associated with rural conditions, making its presence in developed countries of temperate climate areas rare. However, we report the first case of an autochthonous mycetoma case in continental France that originated from a newNocardiaspecies. A Gram-positive filamentous bacterium (OFN 14.177T) was isolated from a pus sample from the mycetoma of a male French patient 92 years old suffering from chronic lymphocytic leukemia. The isolate was analyzed by a polyphasic taxonomic approach by coupling morphological, biochemical, physiological, and chemotaxonomic aspects to genomic and phylogenetic analyses. Multilocus sequence analysis (MLSA) using four housekeeping genes (16S rRNA gene,secA1,hsp65, andsod) combined with phylogenetic analysis revealed that the strain OFN 14.177Tis phylogenetically closer not only toNocardia altamirensisbut also to all other species comprising theNocardia brasiliensisclade (i.e.,N. brasiliensis,N. altamirensis,N. vulneris,N. iowensis, andN. tenerifensis), some of which present cutaneous tropism. The G+C content of isolate OFN 14.177Twas 68.2 mol%. DNA-DNA hybridization analyses demonstrated 38.25% relative reassociation withN. altamirensis. The strain OFN 14.177Tis different from the closest species at genetic and phenotypical levels, and the data obtained indicate that it should be recognized as a new species, for which the name ofNocardia boironiisp. nov. is proposed. The type strain is OFN 14.177T(= EML 1451 = DSM 101696).IMPORTANCEBacterial mycetoma is an endemic infection in areas with tropical and subtropical climates. Thus, its presence in temperate climate areas remains rare. We report here the first case of autochthonous actinomycetoma in continental France originating from aNocardiaspecies other thanN. brasiliensis, namely,Nocardia boironii. Considering the history of the patient, the infection source of strain OFN 14.177Tmay be from frequent contact with the soil over many years because of his gardening activities. The discovery of a French autochthonousNocardiaspecies responsible for actinomycetoma reveals the importance of considering the possibility of having autochthonous infections of this type in nontropical countries, not only imported cases from tropical countries. However, further studies are needed to elucidate the real incidence of this new species.
authors.affiliation: Service de Médecine Interne, Centre Hospitalier de Castres-Mazamet, Castres, France.
authors.forename: Jacques M
authors.initials: JM
authors.lastname: Gilquin
authors.affiliation: Laboratoire de Microbiologie, Centre Hospitalier de Castres-Mazamet, Castres, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Riviere
authors.affiliation: Instituto de Recursos Naturales y Agrobiologia, IRNAS-CSIC, Seville, Spain.
authors.forename: Valme
authors.initials: V
authors.lastname: Jurado
authors.affiliation: Service d'Imagerie Médicale, Centre Hospitalier de Castres-Mazamet, Castres, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Audouy
authors.affiliation: Research Group on Bacterial Opportunistic Pathogens and Environment, UMR 5557, Ecologie Microbienne, French Observatory of Nocardiosis, Université de Lyon, Université de Lyon, CNRS, VetAgro Sup, Lyon, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Kouatche
authors.affiliation: Research Group on Bacterial Opportunistic Pathogens and Environment, UMR 5557, Ecologie Microbienne, French Observatory of Nocardiosis, Université de Lyon, Université de Lyon, CNRS, VetAgro Sup, Lyon, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Bergeron
authors.affiliation: Research Group on Bacterial Opportunistic Pathogens and Environment, UMR 5557, Ecologie Microbienne, French Observatory of Nocardiosis, Université de Lyon, Université de Lyon, CNRS, VetAgro Sup, Lyon, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Mouniée
authors.affiliation: Service d'Anatomie et de Cytologie Pathologiques, Hôpital Necker Enfants Malades, Paris, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Molina
authors.affiliation: Laboratoire d'Anatomie et de Cytologie Pathologiques, Castres, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Faure
authors.affiliation: Instituto de Recursos Naturales y Agrobiologia, IRNAS-CSIC, Seville, Spain.
authors.forename: Cesáreo
authors.initials: C
authors.lastname: Saiz-Jimenez
authors.affiliation: Research Group on Bacterial Opportunistic Pathogens and Environment, UMR 5557, Ecologie Microbienne, French Observatory of Nocardiosis, Université de Lyon, Université de Lyon, CNRS, VetAgro Sup, Lyon, France.
authors.forename: Verónica
authors.initials: V
authors.lastname: Rodríguez-Nava
keywords: MLSA; Nocardia; antibiotic resistance; genotypic identification; mycetoma; phenotypic identification; taxonomy