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Accurate identification of Nocardia species remains a challenge due to the complexities of taxonomy and insufficient discriminatory power of traditional techniques. We report the development of a molecular technique that utilizes real-time PCR-based high-resolution melting (HRM) analysis for differentiation of the most common Nocardia species. Based on a novel fusA-tuf intergenic region sequence, Nocardia farcinica , Nocardia cyriacigeorgica and Nocardia beijingensis were clearly distinguished from one another by HRM analysis. The limit of detection of the HRM assay for purified Nocardia spp. DNA was at least 10 fg. No false positives were observed for specificity testing of 20 non-target clinical samples. In comparison to established matrix-assisted laser desorption/ionization-time of flight MS, the HRM assay improved the identification of N. beijingensis . Additionally, all the products of PCR were verified by direct sequencing. In conclusion, the developed molecular assay allows simultaneous detection and differentiation of N. farcinica , N. cyriacigeorgica and N. beijingensis with high sensitivity and specificity.

Brain abscesses due to Nocardia species account for 1-2% of all cerebral abscesses, often in immunosuppressed individuals, with a mortality three times higher than other cerebral abscesses. Early diagnosis and management are vital for good outcomes. We report a case of a right frontal Nocardia brain abscess in an immunosuppressed 38-year-old female. She presented with headaches, confusion, memory deficits, and personality change. She remained systemically well, with normal inflammatory markers. She underwent two open surgical drainages, with excision of the abscess wall. She made an excellent recovery with minimal edema and no contrast enhancement on imaging at eight weeks postoperatively. Management of Nocardia brain abscess includes a prompt diagnosis with direct microscopic examination and initiation of correct antibiotic therapy for good outcomes. We recommend open surgical resection, including excision of the abscess wall, followed by long-term antimicrobial therapy, to enhance the rate of recovery.

Background The routine identification to the species level of Nocardia genus by conventional methods is a fastidious and time-consuming process owing to the limited biochemical reactivity of these microorganisms, often requiring 1 or more days to complete identification. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) is a new technology for definitive and rapid species identification. Methods We evaluated the MALDI-TOF MS for the identification of 44 clinical isolates of Nocardia species in comparison to 16S ribosomal RNA (rRNA) gene sequencing. Nocardia isolates were identified by microbiological examination, phenotypical tests and MALDI-TOF MS and the results were compared by 16S rRNA gene sequencing. Results Of the 44 Nocardia strains, the identification of 28 isolates was determined with MALDI Biotyper database. According to this, 16 isolates (57.1%) of the strain log scores were ≥2. Two (7.1%) were identified to the species level (log scores of ≥2) as Nocardia otitidiscaviarum. The addition of a newly established Nocardia database (16 new Nocardia strains included to the original database) did significantly improve the scores. The results were 43 (97.7%) correct identification to the species level (log scores of ≥2). Conclusions This study showed that the identification of clinical Nocardia isolates by the Bruker MALDI Biotyper is highly reliable, whereas identification rates are generally lower than those for some Gram-negative bacteria and Gram-positive cocci. Based on our data, the identification rates can be improved by validated new database entries and the results can be confirmed with nucleic acid sequence analysis.

Nocardia is an important cause of clinically invasive disease, but for most clinical laboratories, identification of these isolates to the species level is challenging. Recently, matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) has been widely used for identification of most bacterial and fungal isolates. In this multicenter study, we evaluated the identification of Nocardia isolates using Autof MS1000 and Bruker Biotyper. A total of 86 non-duplicate Nocardia isolates from 7 hospital laboratories were evaluated. Further, we carried out sequence analysis of 16S rRNA, gyrB, secA1, hsp65, and rpoB genes as a reference method for Nocardia species identification. The 86 isolates were directly spotted on the target plate and plate protein extraction was performed. Data were analyzed by SPSS 19.0. In total, 72 (83.7%) strains (score ≥ 9.0) and 70 (81.4%) strains (score ≥ 2.0) were correctly identified by the Autof MS1000 and Bruker Biotyper systems, respectively, at the species level. There was no significant difference (P > 0.05) between the two systems using the same protein extraction method. In conclusion, the Autof MS 1000 and Bruker MALDI-TOF systems showed no difference in identification of Nocardia spp. to the species level and could meet the most important clinical requirement for species identification.

Nocardia species can cause various types of infections including, pulmonary, cutaneous, disseminated & CNS diseases. Here, we report a case of disseminated nocardiosis, probably secondary to pulmonary foci, in an immunocompetent patient. Blood culture showed gram-positive bacilli, which on culture grew aerial chalky white growth showed the acid-fast, gram-positive filamentous bacteria. The culture was identified as Nocardia farcinica by MALDI-TOF. Unfortunately, the patient succumbed to the infection on the 5th day after admission.

A 55-year-old immunocompetent male presented with new-onset seizures and acute respiratory failure requiring intubation and a stay in the medical intensive care unit. Magnetic Resonance Imaging (MRI) of the brain revealed ring-enhancing lesions, and Computed Tomography (CT) chest showed ground-glass opacity. The patient underwent craniotomy and bronchoscopy, followed by culture of the purulent aspirate from lesions in the brain and bronchoalveolar lavage (BAL). After extensive infectious workup, the patient was diagnosed with a Nocardia farcinica brain abscess plus underlying pulmonary alveolar proteinosis (PAP). Based on a recommendation from an infectious disease expert, the patient was treated with trimethoprim-sulfamethoxazole (TMP/SMX). This case highlights the importance of understanding that, though rare, infections such as nocardiosis can present in immunocompetent patients and cause severe morbidity.

Volume 48, no. 12, p. [4525–4533][1], 2010, . Page 4527, Table 2, “Sequence” entry for primer Noc-rpoB-R4: “CCCGCGAGGACATCGTCG” should read “CGSTCSTCGAGGAAGTTGCCGTC.” [1]: /lookup/doi/10.1128/JCM.00883-10

Objective Nocardiosis is a rare opportunistic infection caused by the Nocardia species. Nocardia bacteremia is a life-threatening presentation of disseminated nocardiosis that presents diagnostic and therapeutic challenges. We performed this retrospective analysis in a Chinese hospital from 2010 to 2019 to describe the characteristics of this rare bloodstream infection. Methods We searched the database of the real-time nosocomial infection surveillance system and identified patients whose blood cultures showed Nocardia bacteria growth. The medical records of these patients were extracted and analyzed by two independent researchers. The data included age, gender, complicating disease, duration from blood drawing to reporting, clinical signs and symptoms, blood routine and C-reactive protein results, radiological examinations, sites of involvement, antibiotic treatments, and outcomes. Results Seven patients with Nocardia bacteremia were found. There were four male and three female patients, whose ages ranged from 41 to 75 years. Six (85.7%) patients had predisposing conditions and were administrated corticosteroids for various reasons before the identification of Nocardia infection. The most common symptom was fever (100%). Five patients presented with lung or skin involvement; meanwhile, three patients presented with brain involvement. One patient presented with pelvic and peritoneum involvement, respectively. The most common findings of chest CT imaging were consolidation, followed by nodules and cavitations. Trimethoprim/sulfamethoxazole was prescribed to all patients after the diagnosis of Nocardia bacteremia. Six patients recovered, and one patient ultimately died. Conclusions Nocardia bacteremia is a rare bloodstream infection that usually occurs in immunocompromised patients. Clinical manifestations of patients are nonspecific. It often causes multiple organ involvement, and early diagnosis and prompt aggressive interventions are important to improve the outcome of this disease.

Accurate identification of Nocardia species remains a challenge due to the complexities of taxonomy and insufficient discriminatory power of traditional techniques. We report the development of a molecular technique that utilizes real-time PCR-based high-resolution melting (HRM) analysis for differentiation of the most common Nocardia species. Based on a novel fusA-tuf intergenic region sequence, Nocardia farcinica , Nocardia cyriacigeorgica and Nocardia beijingensis were clearly distinguished from one another by HRM analysis. The limit of detection of the HRM assay for purified Nocardia spp. DNA was at least 10 fg. No false positives were observed for specificity testing of 20 non-target clinical samples. In comparison to established matrix-assisted laser desorption/ionization-time of flight MS, the HRM assay improved the identification of N. beijingensis . Additionally, all the products of PCR were verified by direct sequencing. In conclusion, the developed molecular assay allows simultaneous detection and differentiation of N. farcinica , N. cyriacigeorgica and N. beijingensis with high sensitivity and specificity.

Abscesses caused by the genus Nocardia spp are relatively rare, accounting for approximately 2 % of all brain abscesses, but with a significantly higher mortality. Special stains of brain abscess material from a 60-year-old man showed Gram-positive branching bacilli and the presence of long, acid-fast branching filamentous bacilli suggesting Nocardia infection. Presented here is a case of multidisciplinary management of a patient who developed cerebral abscesses by Nocardia farcinica , confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), that was susceptible to trimethoprim/sulfamethoxazole, linezolid, imipenem and not susceptible to minocycline. This case highlights the importance of performing subtyping and antimicrobial testing in order to improve clinical and treatment outcomes due to patterns of antibiotics resistance among Nocardia species.

Introduction: Nocardia spp are widely distributed group of actinomycetes that occur in a wide range of manmade and natural habitat including activated sewage sludge, soil, water and tissues of plants and animals including human. Nocardia causes many diseases, notably pulmonary infections in man and mastitis in animals. Methods: The study subjects included 300 milk samples and 20 soil samples from different farms in Khartoum State, which include Hilat Koko, Ghandahar, Al Silate and Almuaileh. Distribution of the enrolled milk samples was as follows; 100 from goats, 100 from cows and 100 from sheep. Soil samples distribution was as follows; All target samples were cultured on TSA and GYEA and then Gram’s stain and different biochemical tests were used for further identification. Finally, PCR targeting 16Sr RNA gene was carried out for all Nocardia isolates. Results: Dairy animals included in the present study were found to be infected with Nocardia species with different ratio; goats 13/87 (14.9%%), cows 11/77 (14.2%) and sheep 0/60 (0%). Other pathogenic bacteria were also identified in milk, these included Streptococcus, Dietzia, Rhodococcus and Mycobacteria. Our findings proved also the existence of Nocardia spp. among 35% (7/20) of the soil samples, three samples isolated from farms of Hilat Koko, one sample from Ghandahar, two samples from Al Silate and one samples from Al muaileh. Conclusion In the present study, the Nocardia species were isolated and identified from the soil and milk samples of dairy animals of the same farms by conventional and molecular methods. This finding strongly suggest that soil could be the possible source for the infection of farm animals.

Infections, including intracranial abscesses, are a well-known and potentially serious complication of intravenous drug abuse. There have been increasing reports of intravenous misuse of transdermal Fentanyl, with severe sequelae. Intracranial abscesses in intravenous drug users tend to involve uncommon pathogens, and may present with atypical symptoms, which can lead to delayed diagnosis and inadequate treatment. We present the case of a 28-year-old female, with a history of intravenous misuse of transdermal Fentanyl, who was found to have intracranial abscesses with Fusobacterium nucleatum and Nocardia species, causing significant vasogenic oedema and mass effect.

Pulmonary infections are the most common clinical manifestations of Nocardia species. There is an increase in cases of nocardial infections occurring worldwide attributable to the increase in the immunosuppressed population. The availability of molecular methods has aided the detection of more number of cases as well as unusual species. Still, it remains one of the most underdiagnosed pathogens. Recognition of drug resistance in this organism has now mandated early and precise identification with speciation for effective treatment and management. Nocardial species identity can predict antimicrobial susceptibility and guide clinical management. Here, we report two cases of pulmonary nocardiosis caused by unusual species of Nocardia, namely, N. cyriacigeorgica and N. beijingensis identified by 16S rRNA gene-based sequencing. These cases are being reported for their rarity.

A case of disseminated nocardiosis caused by Nocardia arthritidis in an immunocompromised patient with a history of chronic lymphocytic leukemia and rheumatoid arthritis is presented. This report highlights the use for multilocus sequence typing (MLST) in addition to single gene molecular sequencing to identify rare Nocardia species.

Pulmonary nocardiosis is a severe and uncommon opportunistic infection caused by Nocardia species. We present a patient with cryptogenic organizing pneumonia who was receiving long-term immunosuppressive therapy, whose treatment course was complicated by cutaneous and pulmonary nocardiosis. Tissue cultures confirmed Nocardia brasiliensis. Nocardiosis should be a diagnostic consideration for patients treated with long-term immunosuppression who have worsening pulmonary symptoms and relapsing pustular skin lesions.

Surgical site infection is the second most common nosocomial infection in healthcare facilities. Open-heart surgery is a clean surgery, and sternal wound infection after open-heart surgery has a great impact on the patient both psychologically and financially. Sternal wound infections are preventable infections if stringent infection control practices are followed. Sternal wound infection after cardiac surgery due to Nocardia is very rare. Nocardia species are aerobic actinomycetes ubiquitously found in soil and aquatic habitats. Nocardia are beaded Gram-positive, branching rods that are partially acid fast. We report two cases of post-operative sternal wound infection caused by Nocardia.

This multicenter study was designed to assess the accuracy and reproducibility of the Vitek MS v3.0 matrix-assisted laser desorption ionization–time of flight (MALDI-TOF) mass spectrometry system for identification of Mycobacterium and Nocardia species compared to DNA sequencing. A total of 963 clinical isolates representing 51 taxa were evaluated. In all, 663 isolates were correctly identified to the species level (69%), with another 231 (24%) correctly identified to the complex or group level. Fifty-five isolates (6%) could not be identified despite repeat testing. All of the tuberculous mycobacteria (45/45; 100%) and most of the nontuberculous mycobacteria (569/606; 94%) were correctly identified at least to the group or complex level. However, not all species or subspecies within the M. tuberculosis , M. abscessus , and M. avium complexes and within the M. fortuitum and M. mucogenicum groups could be differentiated. Among the 312 Nocardia isolates tested, 236 (76%) were correctly identified to the species level, with an additional 44 (14%) correctly identified to the complex level. Species within the N. nova and N. transvalensis complexes could not always be differentiated. Eleven percent of the isolates (103/963) underwent repeat testing in order to get a final result. Identification of a representative set of Mycobacterium and Nocardia species was highly reproducible, with 297 of 300 (99%) replicates correctly identified using multiple kit lots, instruments, analysts, and sites. These findings demonstrate that the system is robust and has utility for the routine identification of mycobacteria and Nocardia in clinical practice.

Nocardiaspecies generally grow well on culture media in contrast to limited metabolic activities. Yet there are rare studies that have examined systematically the effect of culture media on the clinical recovery of these Gram-positive branching bacilli, particularly in relation to many recently described or revisedNocardiaspecies. We analyzed 146 clinicalNocardiastrains, of 24 species, recovered at the University of Texas M. D. Anderson Cancer Center from 2002-2018 for their growth on culture media. Among media setups to culture routine bacteria, fungi, and acid-fast bacilli (AFB), the AFB media alone recovered 35 strains as did fungal media with 26 strains and routine media with 10 strains. Seventy five strains were recovered on two and three media setups. On AFB media mostNocardia novastrains (24 of 29) grew, significantly more than all other strains did. Likewise, all four strains ofNocardia mikamiiwere cultivated solely on AFB media. Fungal media yielded all six strains ofNocardia wallaceithat were resistant to tobramycin and/or amikacin; this growth could be explained by the presence of gentamycin in one fungal medium. Specimen source also affected the recovery: moreNocardiastrains grew on every media setup from normally sterile specimens than from nonsterile specimens. These results suggest that diverse culture media support the growth of manyNocardiaspecies. The better recoveries of these organisms from AFB media and fungal media are likely attributable to decontamination of specimens on AFB culture, incorporation of selective antimicrobial agents into the media, and prolonged incubation.

The identification of Nocardia isolates still represents a challenge for matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) despite its acceptance for most bacterial and fungal isolates. In this study we evaluate the identification of Nocardia isolates using direct spotting and an updated database. Overall, 82 Nocardia isolates belonging to 13 species were identified by DNA sequence analysis of the 16S rRNA and secA1 genes. Nine of these well-characterized isolates from 6 Nocardia species were used to create an in-house library. The remaining 73 isolates were directly spotted on the target plate and on-plate protein extraction was performed. The protein spectra obtained were analyzed by MALDI-TOF MS using the BDAL database (Bruker Daltonics) updated with 6,903 MSPs or the combination of this commercial database and our in-house library. As a result, the use of the commercial database alone and in combination with the in-house library yielded 94.5% and 95.9% of correct species-level identifications, respectively, No isolate was misidentified at the genus level with either database. Besides, the use of the in-house library allowed the species-level identification of a N. otitidiscaviarum isolate that could only be identified at the genus-level with a score value1.6 using the commercial database. In conclusion, the implementation of the direct spotting method and the in-house database provided a high rate of correct species assignment of Nocardia isolates despite the low number of isolates added. Further addition of well-characterized Nocardia isolates may ensure the rapid, accurate and inexpensive identification of most isolates encountered in the routine of the microbiology laboratory.

Nocardiosis diagnosis is a major challenge. The clinical features and radiological findings are nonspecific. Traditionally, Nocardia identification is based on colonial and microscopical mor- phology and biochemical tests. However, molecular biology techniques allow a better characteri- zation of species and biotypes. PCR-RFLP of the 65-kDa heat shock protein (HSP) gene provides a rapid, sensitive, and time and labor-efficient method for this proposal. Using this technique, six of eight isolates tested were identified as Nocardia asteroides type VI. PCR-RFLP of the 65-kDa HSP gene could be very useful for determining the incidence of this pathogen in different population groups and its association with susceptibility/resistance profiles to the drugs of choice for treat- ment. This work is the first molecular detection of Nocardia species in Cuba.

We describe a case of pulmonary nocardiosis due to Nocardia asiatica in an immunocompent 64-year-old-female. Wadowsky-Yee-Okuda-α-ketoglutarate (WYOα) agar, a selective media for Legionella species, was useful for the detection based on the growth-inhibition of normal oral flora and growth-promotion of Nocardia species.

Nocardiaspecies are a complex group of organisms considered to belong to the aerobic actinomycetes. Of the validly described species, many have been implicated as the cause of serious human infections, especially in immunocompromised patients. The genus has a complicated taxonomic history; this is especially true forNocardia asteroides, the type species of the genus and previously the most frequently reported nocardial taxon from human specimens. We provide background on the current taxonomy ofNocardia, with a focus on clinically relevant species, and discuss the currently available methods used to accurately identify isolates to the species, complex, or group level.

Central venous catheter-associated bacteraemia caused by Nocardia species is very rare; the diagnosis of nocardiosis in patients with cancer is challenging because its clinical presentation is varied, sometimes mimicking metastases, and the high index of clinical suspicion is required for prompt institution of therapy. Herein, we report a case of nocardial sepsis with native aortic valve endocarditis in a patient with breast cancer in whom multidisciplinary team involvement and prompt initiation of therapy have led to successful outcome.

Background Nocardia species are ubiquitous in nature and mainly cause pulmonary disease in humans; however, they can also infect the central nervous system and skin. The management of cerebellar nocardiosis is troublesome and requires multiple considerations of the severity of the underlying systemic disease, difficulties in identifying the bacterium, and frequent delay in initiating adequate therapy. Case description We report a 52-year-old diabetic female patient with Nocardia paucivorans cerebellar abscesses. Brain magnetic resonance imaging (MRI) revealed innumerable small ring-enhancing lesions of posterior fossa. In this report, we present a case of primary single cerebellar abscesses due to N. paucivorans. Early diagnosis and surgical interventions were significant for the patient. The diagnosis was confirmed by DNA sequencing and the organism was susceptible to trimethoprim-sulfamethoxazole (TMP/SMX). The patient was successfully treated with drugs and surgical excision. Conclusion According to the literature, surgical excision or aspiration of cerebellar abscess seems to provide favorable outcomes. In our experience, a successful outcome was achieved with subtotal resection and prolonged adequate antibiotic therapy.

Actinomycetoma is a chronic granulomatous infection, with Nocardia species being one of the infecting pathogens. Infections caused by N. otitidiscaviarum are relatively rare compared with those caused by other Nocardia species. Conventional methods for the diagnosis of nocardiosis based on phenotypic characterization of the strains (e.g., morphology, histopathology) are relatively time consuming and nonspecific. Molecular techniques have become the better choice for prompt and accurate identification of Nocardia isolates. We report a case of actinomycetoma due to N. otitidiscaviarum characterized by 16S ribosomal RNA (16S rRNA) gene sequence analysis and the long-term follow-up.

BACKGROUND:Nocardiaspecies are rare, opportunistic organisms that cause disease in both immunocompetent and immunocompromised individuals.OBJECTIVE: To investigate the clinical presentations of variousNocardiainfections based on the 16S ribosomal RNA gene of the isolate, as well as related risk factors and susceptibility patterns to antimicrobial agentsMETHODS: Thirteen patients with a diagnosis of nocardiosis were included in the present study. SevenNocardiaspecies were identified by 16S ribosomal RNA. Susceptibility testing was performed using six antimicrobial agents.RESULTS: Five patients were immunocompromised, and eight were immunocompetent with predisposing factors including cystic fibrosis, tuberculosis and ophthalmic infections.Nocardiacaused pulmonary infections in eight patients (61.5%), invasive systemic infections in three patients (23%) and local (ophthalmic) infections in two patients (15.4%). In the patients with pulmonary disease, nocardiosis was caused by six species (Nocardia cyriacigeorgica,Nocardia otitidiscaviarum,Nocardia farcinica,Nocardia carnea,Nocardia testaceaandNocardia asiatica). The seventh species identified in the present study wasNocardia crassostreae.DISCUSSION:N crassostreaeis a multidrug-resistant organism that was reported to be an emerging human pathogen causing invasive nocardiosis in a patient with non-Hodgkin’s lymphoma.N farcinicawas isolated from blood in a patient with breast cancer. None of theNocardiaisolates were resistant to linezolid. OneN otitidiscaviarumisolate was a multidrug-resistant organism. All patients in the present study were treated with the appropriate antibiotics and their condition resolved without further sequelae.CONCLUSIONS: The present study is the first report onN crassostreaeas a human pathogen. The detection of multidrug-resistant species necessitate molecular identification and susceptibility testing, and should be performed for allNocardiainfections. Nocardiosis manifests various clinical features depending on theNocardiaspecies and underlying conditions.

Prior to protein extraction for identification by Vitek MS, mycobacterial and Nocardia samples must be inactivated for safe handling outside the biological safety cabinet ([1][1], [2][2]). Previous studies have shown bead-beating samples for 5 min in 70% ethanol (EtOH) with glass beads followed by a

Introduction: Description of Nocardia infection in lung transplantation (LTx) is limited. Case Report: This study was a retrospective case-series of LTx recipients who were infected with Nocardia species. Nocardia infection was diagnosed in 5 patients out of 87 that underwent LTx from January 2009 to September 2014 at our institution. Their histories are depicted in table 1 and figure 1. Conclusion: Although this organism is capable of producing serious and metastatic disease in this kind of host, early diagnosis and initiation of targeted treatment may allow successful outcomes.

Nocardia species are difficult to identify, a consequence of the ever increasing number of species known and their homogeneous genetic characteristics. 16S rRNA analysis has been the gold standard for identifying these organisms, but proteomic techniques such as matrix-assisted laser desorption ionization-time of flight (MALDI-TOF MS) and housekeeping gene analysis, have also been explored. One hundred high (n = 25), intermediate (n = 20), and low (n = 55) prevalence (for Spain) Nocardia strains belonging to 30 species were identified via 16S rRNA and MALDI-TOF MS analysis. The manufacturer-provided database MALDI Biotyper library v4.0 (5.627 entries, Bruker Daltonik) was employed. In the high prevalence group (Nocardia farcinica, N. abscessus, N. cyriacigeorgica and N. nova), the 16S rRNA and MALDI-TOF MS methods provided the same identification for 76% of the strains examined. For the intermediate prevalence group (N. brasiliensis, N. carnea, N. otitidiscaviarum and N. transvalensis complex), this figure fell to 45%. In the low-prevalence group (22 species), these two methods were concordant only in six strains at the species level. Tetra-gene multi-locus sequencing analysis (MLSA) involving the concatemer gyrB-16S rRNA-hsp65-secA1 was used to arbitrate between discrepant identifications (n = 67). Overall, the MLSA confirmed the results provided at species level by 16S rRNA analysis in 34.3% of discrepancies, and those provided by MALDI-TOF MS in 13.4%. MALDI-TOF MS could be a strong candidate for the identification of Nocardia species, but only if its reference spectrum database improves, especially with respect to unusual, recently described species and species included in the described Nocardia complexes. This work was funded by a grant to NG from the Instituto de Salud Carlos III (MPY 1278/15). Sí

Nocardiosis is a rare disease caused by infection with Nocardia species, aerobic actinomycetes with a worldwide distribution. A rare life-threatening disseminated Nocardia brasiliensis infection is described in an elderly, immunocompromised patient. Microorganism was recovered from bronchial secretions and dermal lesions, and was identified using molecular assays. Prompt, timely diagnosis and appropriate treatment ensured a favorable outcome.