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Park, Son, Song, and Shin: Nocardia abscessus Cutaneous Abscess: A Case Report and Review of the Literature
Original Article

Ann Clin Microbiol 2018;21(3):64-67.

Published online: 10 September 2018

DOI: https://doi.org/10.5145/ACM.2018.21.3.64

Nocardia abscessus Cutaneous Abscess: A Case Report and Review of the Literature

Hee Sue Park1, Bo Ra Son2, Min Suk Song3, Kyeong Seob Shin2

1Department of Laboratory Medicine, Chungbuk National University Hospital, Cheongju, Korea

2Department of Laboratory Medicine, Chungbuk National University College of Medicine, Cheongju, Korea

3Department of Microbiology, Chungbuk National University College of Medicine, Cheongju, Korea

Correspondence: Kyeong Seob Shin, Department of Laboratory Medicine, Chungbuk National University College of Medicine, 1 Chungdaero, Seowon-gu, Cheongju 28644, Korea. (Tel) 82-43-269-6240, (Fax) 82-43-271-5243, (E-mail) ksshin@chungbuk.ac.kr

Received 12 March 2018       Revised 8 June 2018       Accepted 9 June 2018

Copyright © 2018 The Korean Society of Clinical Microbiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We describe a cutaneous abscess caused by Nocardia abscessus in a previously healthy woman. A 74-year-old woman presented with recurrent bullae on her left forearm that developed 1 week prior and was initially suspected to be a cutaneous infection with Mycobacteria or Tinea corporis. Histopathologically, the skin lesion formed an abscess. A smear revealed a few branched Gram-positive filamentous microorganisms that formed a creamy white colony on a blood agar plate after incubation for 3 days. The colony tested negative on acid-fast bacilli (AFB) staining, but was positive on modified AFB staining. The isolate was confirmed to be N. abscessus by 16S rRNA sequencing analysis. The isolate was susceptible to trimethoprim-sulfamethoxazole, amikacin, ce-fotaxime and erythromycin but resistant to penicillin. The patient was treated with clarithromycin but subsequently lost to follow-up. To the best of our knowledge, this is the first report of a human cutaneous infection with N. abscessus in Korea.

Keywords: Cutaneous abscess, Nocardia abscessus, 16S rRNA sequence

References

1. Beaman BL and Beaman L. Nocardia species: host-parasite relationships. Clin Microbiol Rev. 1994; 7:213–64.
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3. Al Tawfiq JA, Mayman T, Memish ZA. Nocardia abscessus brain abscess in an immunocompetent host. J Infect Public Health. 2013; 6:158–61.
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4. Horre R, Schumacher G, Marklein G, Stratmann H, Wardelmann E, Gilges S, et al. Mycetoma due to Pseudallescheria boydii and co-isolation of Nocardia abscessus in a patient injured in road accident. Med Mycobiol. 2002; 40:525–7.
5. Choe WH, Kang JO, Pai HJ, Choi TY. A case of Norcardia asteroids type I induced pneumonia. Ann Lab Med. 2005; 25:324–8.
6. CLSI. Susceptibility testing of mycobacteria, nocardia, and other aerobic actinomycetes; approved standard. CLSI document M24-A. Wayne, PA: Clinical and Laboratory Standards Institute;2003.

Fig. 1.
Phylogenetic tree of the current isolate (CBU 05/1969: 1,362 bp) and Nocardia species. The 16S rRNA gene sequences of Nocardia species available in GenBank were aligned using CLUSTAL V and the phylogenetic tree was generated by the neighbor-joining method. Bootstrap values (%) are shown near their corresponding branches; ‘0.1’ indicates 0.1 nucleotide substitutions per site.
acm-21-64f1.tif
Table 1.
Clinical characteristics and diagnostic tools for the patients with primary cutaneous Nocardiosis in Korea
Pathogen Age/ sex Subtype Predisposing factors Underlying disease Diagnostic tools Treatment regimen
N. asteroides [8] 42/F LC Traumatic injury No Biochemical TMP/SXT, 6 m
N. brasiliensis [9] 64/M SC Chemotherapy Thymoma 16S rRNA TMP/SXT+IMP+AMK
N. brasiliensis [10] 68/M SC Traumatic injury Cardiomyopat thy 16S rRNA TMP/SXT, 6 m
N. brasiliensis [11] 68/M SC Steroid injection Cushing synd drome 16S rRNA TMP/SXT+CRO, 3 m
N. brasiliensis [12] 56/M LC Prednisolone/chemotherapy Lung cancer 16S rRNA TMP/SXT, 6 m
N. farcinica [13] 67/M Mycetoma Not described DM 16S rRNA CPD, 4 w+Surgery
N. nova [14] 51/M LC Immunosuppressive agents ESRD 16S rRNA+secA1 CRO, 9 w & TMP/SXT, 4 m
N. abscessus* 74/F SC   Unknown 16S rRNA CLM 2 w+Cryoth

Abbreviations: M, male; F, female; LC, lymphocutaneous; SC, superficial cutaneous; DM, diabetes mellitus; ESRD, end stage of renal disease; 16S rRNA, 16S ribosomal RNA sequencing analysis; secA1, secA1 sequence; TXP/SXT, trimethoprim/sulfamethoxazole; IMP, imipenem; AMK, amikacin; CRO, ceftriaxone; CPD, cefpodoxime; CLM, clarithromycin; Cryoth, Cryotherapy; m, month; w, week.

* Present study.

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