ARTICLE
Clinical and microbiological characteristics of infections
caused by various Nocardia species in Taiwan: a multicenter
study from 1998 to 2010
W. L. Liu
&
C. C. Lai
&
W. C. Ko
&
Y. H. Chen
&
H. J. Tang
&
Y. L. Huang
&
Y. T. Huang
&
P. R. Hsueh
Received: 9 January 2011 / Accepted: 9 March 2011 / Published online: 3 April 2011
#
Springer-Verlag 2011
Abstract This multicenter study in Taiwan investigated the
clinical presentations of various Nocardia species infections
based on 16S rRNA sequence analysis. Patients with
nocardiosis in four large medical centers from 1998 to
2010 were included. A total of 100 preserved nonduplicate
isolates causing human infection were identified as Nocar-
dia species. Sequencing analysis of 16S rRNA confirmed
that 35 of 36 N. asteroides isolates identified by conven-
tional tests were non-asteroides Nocardia species, and that
two of 50 N. brasiliensis isolates had also been initially
misidentified. N. brasiliensis (50%) was the most common
pathogen, followed by N. cyriacigeorgica (18%). In
addition, several rare pathogens were identified, including
N. asiatica, N. rhamnosiphila, N. abscessus, N. trans-
valensis, N. elegans, and N. carnea. Primary cutaneous
infection was the most common presentation, noted in 55
(55%) patients, while pulmonary infection presented in 26
(26%) patients. The crude mortality rate was 6.7% (6/89),
and was lowest for primary cutaneous infection (2.2%) and
highest for disseminated disease and pulmonary infection
(16.7%). In conclusion, N. brasiliensis and N. cyriaci-
georgica were the most common pathogens causing
nocardiosis in Taiwan. Molecular methods for identifying
Nocardia to the species level are mandatory for better
understanding the epidemiology and clinical characteristics
of patients with nocardiosis.
Introduction
Nocardia species are aerobic actinomycetes, which are
ubiquitous in soil and can cause local and disseminated
infection, especially in immunocompromised patients
[1, 2]. This group of organisms can be found extensively
worldwide and their genus is rapidly expanding, with at
least 80 species described do date (http://www.bacterio.cict.
fr/n/nocardia.html). However, only about 30 members of
the Nocardia species have been reported to cause human
disease [3]. Furthermore, the geographical prevalence of
each species may vary greatly throughout the world, and
some species are more prevalent in geographical locations
with a specific climate [3]. Thus, epidemiologic study is
W. L. Liu
:
C. C. Lai
Department of Intensive Care Medicine, Chi Mei Medical Center,
Liouying, Tainan, Taiwan
W. C. Ko
Department of Internal Medicine,
National Cheng Kung University Medical College and Hospital,
Tainan, Taiwan
Y. H. Chen
Department of Internal Medicine,
Kaohsiung Medical University Hospital,
Kaohsiung Medical University,
Kaohsiung, Taiwan
H. J. Tang
Department of Internal Medicine, Chi Mei Medical Center,
Tainan, Taiwan
Y. L. Huang
Department of Pediatrics, Cathay General Hospital,
Taipei, Taiwan
Y. T. Huang
:
P. R. Hsueh (*)
Departments of Laboratory Medicine and Internal Medicine,
National Taiwan University Hospital,
National Taiwan University College of Medicine,
Taipei, Taiwan
e-mail: hsporen@ntu.edu.tw
Eur J Clin Microbiol Infect Dis (2011) 30:1341–1347
DOI 10.1007/s10096-011-1227-9