Nocardia veterana , a New Emerging Pathogen

Abstract

Nocardia veterana is a newly described species named after the veteran's hospital where it was first isolated. This initial type strain was not thought to be clinically significant. We describe three cases of pulmonary disease attributable to N. veterana: two cases in patients presenting with multiple pulmonary nodules in a setting of immunocompromise and one case of exacerbation of chronic pulmonary disease. The isolates were susceptible to ampicillin, imipenem, gentamicin, amikacin, and trimethoprim-sulfamethoxazole and had reduced susceptibilities to ceftriaxone, cefotaxime, minocycline, and ciprofloxacin. The MICs of amoxicillin-clavulanate were higher than that of ampicillin alone, and the bacteria produced a beta-lactamase detectable only after induction with clavulanic acid. Phenotypically, the isolates could not be characterized beyond the Nocardia genus level. All three isolates were definitively identified as N. veterana by PCR and sequencing of the 16S rRNA gene. On the basis of their susceptibility and restriction enzyme analysis profiles, our findings indicate that they could potentially be misidentified as N. nova. These cases illustrate the pathogenic potential of this newly described species and emphasize the importance of accurate identification of Nocardia isolates to the species level by integrated use of phenotypic and genotypic methods.

Use of PCR-Restriction Enzyme Pattern Analysis and Sequencing Database for hsp65 Gene-Based Identification of Nocardia Species

“…africana, N. cummidelens, N. nova, N. soli, and N. veterana. These results confirmed that PRA is unsuitable for delineating the new nocardial taxonomic background (8,22). Moreover, we found that the PRA pattern for N. abscessus, previously included in the N. asteroides type I subspecies, differed from the profile reported by Steingrube (Fig.…”

Nocardia kruczakiae sp. nov., a Pathogen in Immunocompromised Patients and a Member of the “ N. nova Complex”

“…The MICs of amoxicillin-clavulanate for all species were higher than those of ampicillin alone. This discrepancy has been noted previously for some Nocardia isolates and has been attributed to the ability of clavulanic acid to act as a beta-lactamase inducer (8,12). While susceptibility testing has been shown to assist in the identification of several of the more commonly isolated Nocardia species (13)(14)(15), it appears that the use of susceptibility testing alone would be inadequate for the reliable identification of isolates belonging to this group.…”

“…Organisms comprising the "Nocardia asteroides complex" have now been more completely characterized and have been shown to be genetically distinct species (9,10,17,18). More recently, such methodologies have revealed that some isolates determined to belong to Nocardia nova by phenotypic and heat shock protein (HSP) restriction fragment length polymorphisms (RFLPs) actually belong to the distinct species Nocardia veterana (2,8).…”

Lung Diseases - Selected State of the Art Reviews

“…Nowadays, taxonomy of this genus has undergone considerable changes due to modern molecular techniques, such as identification by 16S ribosomal RNA gene sequencing. New species have been described, such as N. cryacigeorgica (Schlaberg et al, 2008), N. veterana (Pottumarthy et al, 2003), N. abscessus (Yassin et al, 2000), N. paucivorans (Eisenblatter et al, 2002) and N. kruczakiae (Conville et al, 2004), which should be taken into account in case of isolation in LTx samples.…”