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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/09/30 22:27:12」(JST)

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Nocardia as found on a brain biopsy.

Nocardia is a genus of weakly staining Gram-positive, catalase-positive, rod-shaped bacteria. It forms partially acid-fast beaded branching filaments (acting as fungi, but being truly bacteria). It has a total of 85 species. Some species are non-pathogenic while others are responsible for nocardiosis.^[1] Nocardia are found worldwide in soil that is rich with organic matter. In addition, Nocardia are oral microflora found in healthy gingiva as well as periodontal pockets. Most Nocardia infections are acquired by inhalation of the bacteria or through traumatic introduction.

Culture and staining

Nocardia colonies have a variable appearance, but most species appear to have aerial hyphae when viewed with a dissecting microscope, particularly when they have been grown on nutritionally limiting media. Nocardia grow slowly on non-selective culture media, and are strict aerobes with the ability to grow in a wide temperature range. Some species are partially acid fast (meaning that a less concentrated solution of sulfuric or hydrochloric acid should be used during the staining procedure) due to the presence of intermediate-length mycolic acids in their cell wall. Majority of strains possess the cord factor (trehalose 6-6' dimycolate) an important virulence factor.

They are catalase positive and can grow easily on the most commonly used media with colonies becoming evident in 3–5 days. However sometimes prolonged incubation periods (2–3 weeks) are needed.

The genus includes at least 30 different species with ten of them isolated from humans.

Virulence

The various species of Nocardia are pathogenic bacteria with low virulence; therefore clinically significant disease most frequently occurs as an opportunistic infection in those with a weak immune system, such as small children, the elderly, and the immunocompromised (most typically, HIV). Nocardial virulence factors are the enzymes catalase and superoxide dismutase (which inactivate reactive oxygen species that would otherwise prove toxic to the bacteria), as well as a "cord factor" (which interferes with phagocytosis by macrophages by preventing the fusion of the phagosome with the lysosome).

Clinical disease and microbiological diagnosis

Nocardia asteroides is the species of Nocardia most frequently infecting humans, and most cases occur as an opportunistic infection in immunocompromised patients. Other species of medical interest are N. brasiliensis and N. caviae. Because it is acid-fast to some degree, it stains only weakly gram positive.

The most common form of human nocardial disease is a slowly progressive pneumonia, whose common symptoms include cough, dyspnea (shortness of breath), and fever. It is not uncommon for this infection to spread to the pleura or chest wall. Pre-existing pulmonary disease, especially pulmonary alveolar proteinosis, increases the risk of contracting a Nocardia pneumonia. Every organ can be affected if a systemic spread takes place.

Nocardia spp are deeply involved in the process of endocarditis as one of its main pathogenic effects.

In about 25–33% of people Nocardia infection will take the form of encephalitis and/or brain abscess formation.

Nocardia may also cause a variety of cutaneous infections such as actinomycetoma (especially Nocardia brasiliensis), lymphocutaneous disease, cellulitis and subcutaneous abscesses.

Nocardia isolation from biological specimens can be performed using agar medium enriched with yeast extract and activated charcoal (BCYE), the same utilized for Legionella spp. Selective media for Mycobacteria or fungi can also be inoculated. The most suitable specimens are the sputum or, when clinically necessary, bronchoalveolar lavage or biopsy. Further biochemical tests for species identification are not routinely performed. Serological or cutaneous tests are not available.

Treatment

Antibiotic therapy with a sulfonamide, most commonly trimethoprim-sulfamethoxazole, is the treatment of choice.^[2] People who take trimethoprim-sulfamethoxazole for other reasons, such as prevention of Pneumocystis jirovecii infection, appear to have fewer Nocardia infections,^[3] although this protective effect has been considered unreliable^[4] and some studies have disputed it altogether.^[5] Minocycline is usually substituted when a sulfa cannot be given; high-dose imipenem and amikacin have also been used in severe or refractory cases.^[2] Linezolid appears to be highly effective against Nocardia, but it is very expensive and may cause severe adverse effects.^[6]

Antibiotic therapy is continued for six months (in immunocompetent people) to a year (in immunosuppression), and may need to be continued indefinitely.^[2] Proper wound care is also critical.

Genetics

Although Nocardia has interesting and important features such as production of antibiotics and aromatic compound-degrading or converting enzymes, the genetic study of this organism has been hampered by the lack of genetic tools. However, practical Nocardia–E. coli shuttle vectors have been developed recently.^[7]

It has also recently been found that the genera Nocardia and Rhodococcus are closely related. A close relationship between them is supported by two conserved signature indels consisting of a 1 amino acid deletion in the alpha subunit of acetyl coenzyme A carboxylase (ACC), as well as a 3 amino acid insertion in a conserved region of an ATP-binding protein that are specifically shared by species from these two genera. In addition, 14 hypothetical conserved signature proteins have been identified which are unique to the genera Nocardia and Rhodococcus.^[8]

References

^ Ryan KJ; Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 460–2. ISBN 0-8385-8529-9.
^ ^a ^b ^c Bartlett JG (October 5, 2007). "Nocardia". Point-of-Care Information Technology ABX Guide. Johns Hopkins University. Retrieved on January 3, 2009. Freely available with registration.
^ Muñoz P, Muñoz RM, Palomo J, Rodríguez-Creixéms M, Muñoz R, Bouza E (November 1997). "Pneumocystis carinii infection in heart transplant recipients. Efficacy of a weekend prophylaxis schedule". Medicine (Baltimore) 76 (6): 415–22. doi:10.1097/00005792-199711000-00004. PMID 9413427.
^ Peleg AY, Husain S, Qureshi ZA, et al. (May 2007). "Risk factors, clinical characteristics, and outcome of Nocardia infection in organ transplant recipients: a matched case-control study". Clin Infect Dis 44 (10): 1307–14. doi:10.1086/514340. PMID 17443467. Lay summary – Doctor's Guide.
^ Khan BA, Duncan M, Reynolds J, Wilkes DS (2008). "Nocardia infection in lung transplant recipients". Clin Transplant 22 (5): 562–6. doi:10.1111/j.1399-0012.2008.00824.x. PMID 18435787.
^ Jodlowski TZ, Melnychuk I, Conry J (October 2007). "Linezolid for the treatment of Nocardia spp. infections". Ann Pharmacother 41 (10): 1694–9. doi:10.1345/aph.1K196. PMID 17785610.
^ Chiba K, Hoshino Y, Ishino K, Kogure T, Mikami Y, Uehara Y, Ishikawa J (2007). "Construction of a Pair of Practical Nocardia-Escherichia coli Shuttle Vectors". Jpn J Infect Dis 60 (1): 45–7. PMID 17314425.
^ Gao, B.; Gupta, R. S. (2012). "Phylogenetic Framework and Molecular Signatures for the Main Clades of the Phylum Actinobacteria". Microbiology and Molecular Biology Reviews 76 (1): 66–112. doi:10.1128/MMBR.05011-11. PMC 3294427. PMID 22390973. edit

External links

Genome sequence of N. farcinica IFM 10152
MicrobeWiki's N. farcinica Page, Current as of June 2007

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. ノカルジア症の治療 treatment of nocardiosis
2. ノカルジア症の臨床症状および診断 clinical manifestations and diagnosis of nocardiosis
3. ノカルジア症の微生物学、疫学、および病因 microbiology epidemiology and pathogenesis of nocardiosis
4. 脳膿瘍の病因、臨床症状、および診断 pathogenesis clinical manifestations and diagnosis of brain abscess
5. 高熱および肺浸潤を有する免疫不全患者へのアプローチ approach to the immunocompromised patient with fever and pulmonary infiltrates

English Journal

Identification of Nocardia Species by Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry.

Khot PD1, Bird BA1, Durrant RJ2, Fisher MA3.
Journal of clinical microbiology.J Clin Microbiol.2015 Oct;53(10):3366-9. doi: 10.1128/JCM.00780-15. Epub 2015 Aug 12.
Matrix-assisted laser desorption ionization-time of flight mass spectrometry for identification of Nocardia species remains challenging. By identifying 83.1% (64 of 77) and 80% (8 of 10) to the species and complex levels, respectively, and 94.3% (82 of 87) to the genus level, we show that an approac
PMID 26269617

NOCARDIA CHOROIDAL ABSCESS: Risk Factors, Treatment Strategies, and Visual Outcomes.

Silva RA1, Young R, Sridhar J; Nocardia Study Group.
Retina (Philadelphia, Pa.).Retina.2015 Oct;35(10):2137-46. doi: 10.1097/IAE.0000000000000599.
PURPOSE: To describe the risk factors, clinical course, ancillary test findings, treatment strategies, and visual outcomes of a series of patients with choroidal abscesses caused by endogenous Nocardia.METHODS: This retrospective, consecutive noncomparative case series included all patients with Noc
PMID 25978732

Nocardia asteroides Keratitis Resistant to Amikacin.

Patel R1, Sise A, Al-Mohtaseb Z, Garcia N, Aziz H, Amescua G, Pantanelli SM.
Cornea.Cornea.2015 Sep 28. [Epub ahead of print]
PURPOSE: To describe 2 cases of Nocardia keratitis resistant to topical compounded amikacin therapy.METHODS: A 24-year-old woman presented with a corneal infiltrate. Cultures were taken, and topical moxifloxacin was administered. Corneal biopsy was performed when clinical status deteriorated, which
PMID 26418432

Japanese Journal

白内障術後のNocardia感染による結膜下膿瘍の1例 (特集第65回日本臨床眼科学会講演集(8))

芹澤元子,國重智之,高橋浩
臨床眼科 66(10), 1515-1518, 2012-10
NAID 40019462697

陥凹性の気道内病変を認めたノカルジア症の1例

大家理伸,中村保清,吉田真教 [他]
感染症学雑誌 = The journal of Japanese the Association for Infectious Diseases 86(5), 592-596, 2012-09
NAID 40019436973

Related Pictures

★リンクテーブル★

リンク元	「細菌の鑑別」「細胞内寄生菌」「ノカルジア属」「nocardial」
拡張検索	「Nocardia asteroides」「Nocardiaceae」

「細菌の鑑別」

Nocardia
	Nocardia asteroides (yellow colonies).
Scientific classification
Kingdom:	Bacteria
Phylum:	Actinobacteria
Class:	Actinobacteria
Order:	Actinomycetales
Suborder:	Corynebacterineae
Family:	Nocardiaceae
Genus:	Nocardia; Trevisan 1889
Species
	N. aerocolonigenes; N. africana; N. argentinensis; N. asteroides; N. blackwellii; N. brasiliensis; N. brevicatena; N. carnea; N. caviae; N. cerradoensis; N. corallina; N. cyriacigeorgica; N. dassonvillei; N. elegans; N. farcinica; N. nigiitansis; N. nova; N. opaca; N. otitidis-cavarium; N. paucivorans; N. pseudobrasiliensis; N. rubra; N. seriolae; N. transvelencesis; N. uniformis; N. vaccinii; N. veterana;

　　[★]

関: 細菌

グラム陽性菌の鑑別 LAB.994

菌種	形態	抗酸性	芽胞	運動性	空気中での発育	嫌気条件下での発育	カタラーゼ	オキシダーゼ	ブドウ糖分解	OF試験
Micrococcus	C	－	－	－	＋	－	＋	－	D	O/－
Staphylococcus	C	－	－	－	＋	＋	＋	－	＋	F
Aerococcus	C	－	－	－	＋	W	W/－	－	＋	F
Streptococcus	C	－	－	＋/－	＋	＋	－	－	＋	F
Pediococcus	C.	－	－	－	＋	＋	－	－	＋	F
Gemella	C.	－	－	－	＋	＋	－	－	＋	F
嫌気性球菌*1	C	－	－	－	－	＋	－	－	＋/－	F/－
Kurthia	R	－	－	＋	＋	＋	＋	－	－	－
Corynebacterium	R	－	－	－	＋	＋	＋	－	＋/－	F/－
Listeria	R	－	－	＋	＋	＋	＋	－	＋	F
Erysipelothnx	R		－	－	＋	＋			＋	F
Lactobacillus
Arachnia*2
Rothia	R	－	－	－	＋	－	＋	●	＋	F
Propiombacterium	R	－	－	－	－	＋	＋	.	＋	F
Achnomyces	R	－	－	－	－	＋	－	●	＋	F
Bifidobacterium
Eubacterium	R	－	－	－	－	＋	－	.	＋/－	F/－
Clostridium	R	－	<＋>	D	－	＋	－	●	D	F/－
Bacillus	R	－	<＋>	D	＋	D	＋	d	D	F/O/－
Nocardia	R	W	－	－	＋	－	＋	－	＋	O
Mycobacterium	R	＋	－	－	＋	.	＋	－	＋	O/NT
1:Peptococcus, Peptostreptococus(あるいは Leuconostoc) 2:あるいはActinomyces odontolyticus D:その属の菌種によって反応が異なる。　d: 菌種によって反応が異なる。 F:発酵 O:酸化 W:弱反応・:不明 NT:テストできない <＋>:芽胞非形成筋もある C:球菌 R:桿菌

グラム陰性菌の鑑別 LAB.995

(再編集の時に－*に注意)

菌種	形態	運動性	空気中での発育	嫌気条件下での発育	カタラーゼ	オキシダーゼ	ブドウ糖(酸)	OF試験
Bacteroides	R	－	－	＋	d	－	D	F/－
Veillonella	C	－	－	＋	D	・	－	－
Neissena	C	－	＋	－	＋	＋	＋	O
Branhamella	C	－	＋	－	＋	＋	－	－
Acinetobacter	C/R	－	＋	－	＋	－	＋	O
Moraxella	R	－	＋		＋	＋	－
Brucella
Bordetella
Chromobacterium lividum	R	＋	＋	－	＋	＋	＋	O
Alcahsenes	R	＋	＋	－	＋	＋	－	－
Flavobacterium	R	－	＋	－	＋	＋	＋	O
Pseudomonas	R	＋	＋	＋	＋	＋	＋	O
Actinobacillus	R	－	＋	＋	＋	＋	＋	F
Pasteurella
Necromonas
Cardiobacterium	R	－	＋	＋	－	＋	＋	F
Chromobacterium violaceum
Beneckea	R	＋	＋	＋	＋	＋	＋	F
Vibrio
Plesiomonas
Aeromonas
腸内細菌	R	D	＋	＋	＋	－	＋	F
Haemophilus	R	－	＋	＋	D	－	D	NT
Eikenella	R	－	－*	＋	－	＋	－	－
Campylobacter	R	＋	－+1	－	D	＋	－	－
Streptobacillus+2	R	－	＋	＋	－	－	＋	F
マイコプラズマ	R	－	＋	＋	－	－	＋	F
1:Peptococcus, Peptostreptococus(あるいは Leuconostoc) 2:あるいはActinomyces odontolyticus D:その属の菌種によって反応が異なる。　d: 菌種によって反応が異なる。 F:発酵 O:酸化 W:弱反応・:不明 NT:テストできない <＋>:芽胞非形成筋もある C:球菌 R:桿菌・: 不明 *: 空気中では発育せず。空気CO2で発育。+1: 好気的または嫌気的には発育せず。5-6%O2中で発育。+2: あるいはShigella dysenteriae 1

「細胞内寄生菌」

　　[★]

英: intracellular organism, intracellular epiphyte
同: 細胞内寄生、細胞外寄生菌

宿主細胞内環境で増殖する細菌の総称

マクロファージ内で生存、増殖することができる。

ファゴソームとリソソームの融合阻止などによりマクロファージの細胞内で増殖できることが特徴であり、細胞外で増殖できないと言うことではない。

分類

通性細胞内寄生菌：細胞内でも細胞外でも増殖できる。
偏性細胞内寄生菌：細胞内でしか増殖できない

	細胞内寄生菌	細胞外寄生菌
生体防御反応	肉芽腫形成	膿瘍を形成

偏性細胞内寄生菌と通性細胞内寄生菌

偏性細胞内寄生菌	リケッチア、クラミジア、らい菌？
通性細胞内寄生菌	結核菌, リステリア属菌, サルモネラ属菌(チフス菌、パラチフス菌、サルモネラ症を起こす菌), ブルセラ属菌, 梅毒トレポネーマ, レジオネラ属菌

表：細胞内増殖：SMB. 111

ファゴソーム内で増殖(リソソームの融合を起こさせない)

ファゴソームを破砕し細胞質内に逃げ込む

Nocardia
Shigella
Rickettsia
Trypanosoma

リソソームの融合が起きる、あるいはファゴソームを修飾する

「ノカルジア属」

　　[★]

ラ: Nocardia
同: Nocardia属、ノカルジア
関: ノカルジア症、細菌

first aid step1 2006 p.139

放線菌目 Actinomycetales

放線菌類

放線菌目の中で菌糸を作らないマイコバクテリア科を除く菌種を指す。好気性のノカルジア属と嫌気性の放線菌属が含まれる (SMB. 292)

グラム陽性桿菌
放線菌に似て分枝した桿菌として認められる。
偏性好気性菌
カタラーゼ陽性
運動性無し

分布

土壌など自然界に広く存在

a gram-positive and also a weakly acid-fast aerobe in soil, causes pulmonary infection in immunocompromised patients.

ノカルジア属

Nocardia asteroides

感染症

ノカルジア症
経気道感染
外傷の創傷部位からの感染

「nocardial」

　　[★]

ノカルジアの

関: Nocardia

「Nocardia asteroides」

　　[★]

英: Nocardia asteroides
関: ノカルジア属、細菌

グラム陽性桿菌
好気性細菌　(⇔[[]]

感染症

ノカルジア症

「Nocardiaceae」

　　[★]

ノカルジア科

カルジア科

関: Nocardia

[Sherris-1] Ryan KJ; Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 460–2. ISBN 0-8385-8529-9.

[POC-IT-2] Bartlett JG (October 5, 2007). "Nocardia". Point-of-Care Information Technology ABX Guide. Johns Hopkins University. Retrieved on January 3, 2009. Freely available with registration.

[3] Muñoz P, Muñoz RM, Palomo J, Rodríguez-Creixéms M, Muñoz R, Bouza E (November 1997). "Pneumocystis carinii infection in heart transplant recipients. Efficacy of a weekend prophylaxis schedule". Medicine (Baltimore) 76 (6): 415–22. doi:10.1097/00005792-199711000-00004. PMID 9413427.

[4] Peleg AY, Husain S, Qureshi ZA, et al. (May 2007). "Risk factors, clinical characteristics, and outcome of Nocardia infection in organ transplant recipients: a matched case-control study". Clin Infect Dis 44 (10): 1307–14. doi:10.1086/514340. PMID 17443467. Lay summary – Doctor's Guide.

[5] Khan BA, Duncan M, Reynolds J, Wilkes DS (2008). "Nocardia infection in lung transplant recipients". Clin Transplant 22 (5): 562–6. doi:10.1111/j.1399-0012.2008.00824.x. PMID 18435787.

[6] Jodlowski TZ, Melnychuk I, Conry J (October 2007). "Linezolid for the treatment of Nocardia spp. infections". Ann Pharmacother 41 (10): 1694–9. doi:10.1345/aph.1K196. PMID 17785610.

[Chiba_2007-7] Chiba K, Hoshino Y, Ishino K, Kogure T, Mikami Y, Uehara Y, Ishikawa J (2007). "Construction of a Pair of Practical Nocardia-Escherichia coli Shuttle Vectors". Jpn J Infect Dis 60 (1): 45–7. PMID 17314425.

[8] Gao, B.; Gupta, R. S. (2012). "Phylogenetic Framework and Molecular Signatures for the Main Clades of the Phylum Actinobacteria". Microbiology and Molecular Biology Reviews 76 (1): 66–112. doi:10.1128/MMBR.05011-11. PMC 3294427. PMID 22390973. edit

匿名

検索

案内

案内

Nocardia