Chapter 27 : , and Other Aerobic Actinomycetes

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This chapter talks about aerobic that are now known to be an evolutionarily heterogeneous assemblage of genera. At some stage they all form gram-positive rods, and most of the more commonly isolated species exhibit at least rudimentary branching under certain growth conditions; all grow better under aerobic than anaerobic conditions, a feature distinguishing them from most organisms in the genus . In temperate climates, the respiratory tract is the most frequent portal of entry for the aerobic actinomycetes and therefore the primary site of nocardial infections in the immunocompromised host. PCR paired with restriction endonuclease analysis (REA) has been used for the identification of commonly isolated species. With REA of a portion of the HSP gene, Steingrube et al. were able to differentiate among 12 taxonomic groups of Nocardia, in addition to species of , , , , and . The recommended procedure for and the other aerobic is broth microdilution; and panels containing the appropriate dilutions of antimicrobials specifically active against these genera are commercially available. Most isolates of species are susceptible to trimethoprim-sulfamethoxazole; one should be careful not to assume too readily that an isolate is resistant to this combination of drugs. The chapter finally points out that sulfonamides or trimethoprim-sulfamethoxazole may not be adequate in certain circumstances, such as patients with central nervous system (CNS) nocardiosis, disseminated disease, or concurrent HIV infection.

Citation: Conville P, Witebsky F. 2011. , and Other Aerobic Actinomycetes, p 443-471. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch27

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Restriction Fragment Length Polymorphism
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Image of FIGURE 1

Classification of genera of aerobic actinomycetes considered to be human pathogens. Information from J. P. Euzéby (LPSN; www.bacterio.cict.fr).

Citation: Conville P, Witebsky F. 2011. , and Other Aerobic Actinomycetes, p 443-471. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch27
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Image of FIGURE 2

Colonial morphology of type strains of various aerobic actinomycetes grown on Sabouraud dextrose agar (Emmons modification) unless otherwise noted. While appearances are typical for the species illustrated, the extent of possible colonial variation within a given species is not known. (A) at 21 days; smooth umbilicate colonies with no aerial hyphae. (B) at 10 days; ropy but smooth-surfaced colony with no aerial hyphae. (C) at 10 days; rugose colony with some aerial hyphae. (D) at 10 days; umbilicate colonies; sparse aerial hyphae present, but visible only on microscopic inspection of colonies. (E) at 25 days; aerial hyphae present. (F) at 21 days; aerial hyphae present. (G) at 7 days; rugose colony; sparse aerial hyphae present, visible only on careful microscopic inspection. (H) at 10 days; smooth colonies with no aerial hyphae. (I) at 10 days; irregular but smooth surface with no aerial hyphae. (J) at 10 days; smooth colonies with no aerial hyphae. (K) at 10 days; rough colonies with no aerial hyphae. (L) at 10 days; dense powdery aerial hyphae cover most or all the surface of the colonies. (M) at 15 days on Middlebrook agar; rough colonies with no aerial hyphae. (N) at 15 days; smooth colonies with no aerial hyphae. (O) at 15 days; mucoid colonies.

Citation: Conville P, Witebsky F. 2011. , and Other Aerobic Actinomycetes, p 443-471. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch27
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Image of FIGURE 3

Microscopic morphology of various aerobic actinomycetes. All photomicrographs taken at 31,000 magnification. (A) Gram stain from Tween-albumin broth (TAB) at 4 days; long, branching, relatively solidly staining rods. (B) Gram stain from TAB at 4 days; long beaded rods with some branching. (C) Gram stain from TAB at 4 days; coryneform rods with no obvious branching. (D) Gram stain from Sabouraud dextrose agar at 14 days in CO; dense aggregates of cells of varying sizes; note the chains of longitudinally and transversely dividing cells near the top. (E) Gram stain from TAB at 10 days; long, beaded, branching rods; note that the beads generally do not abut one another. (F) modified acid-fast stain from horse blood agar at 2 to 3 days; many coccal forms are present; it is mostly these that are staining modified acid-fast positive. (G) modified acid-fast stain from TAB at 25 days; some long, branching forms are staining modified acid-fast positive. (H) Gram stain from TAB at 4 days; coccobacilli and short coryneform rods without obvious branching. (I) modifed acid-fast stain from charcoal yeast extract (CYE) agar at 10 days; only a small percentage of the cells stain positive. (J) modified acid-fast stain from Lowenstein-Jensen medium at 4 days; thin rods, many of which stain positive. (K) Direct Gram stain of sputum that grew a species; note the lacy network of long, thin, branching, beaded rods (courtesy of Daniel P. Fedorko). (L) Direct modified acid-fast stain of the same specimen as in panel K; the beads are purplish, but the intervening areas of the organism stain positive (courtesy of Daniel P. Fedorko). (M) Kinyoun stain from Middlebrook at 12 days. (N) Gram stain from TAB at 7 days. (O) Gram stain from TAB at 5 days.

Citation: Conville P, Witebsky F. 2011. , and Other Aerobic Actinomycetes, p 443-471. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch27
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