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Chapter 27 : , and Other Aerobic Actinomycetes

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Abstract:

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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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
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
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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Tables

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TABLE 1

Morphologic characteristics of genera of aerobic actinomycetes

Abbreviations: V, variable; Neg, negative; Pos, positive; NF, test result not found; W, weak positive.

Colonial morphology descriptions are from various references, the authors of which used a variety of different media; see reference for more information.

Included for completeness; some consider and to be aerobic actinomycetes.

Aerial hyphae may be produced in an increased CO atmosphere.

Original description was Pos.

Sparse aerial hyphae may be produced by .

Occasionally no aerial hyphae produced.

Occasional rudimentary aerial hyphae seen.

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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TABLE 2

Chemotaxonomic and lysozyme growth characteristics of genera of aerobic actinomycetes

Abbreviations: V, variable; Neg, negative; NA, not applicable; Pos, positive; NF, test result not found.

Cell wall types: I, l-DAP, no sugars; III, -DAP, madurose or no sugars; IV, -DAP, arabinose, and galactose.

Included for completeness; some consider and to be aerobic actinomycetes.

Cell wall contains -DAP; no data regarding cell wall sugars found.

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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TABLE 3

Species of aerobic actinomycetes other than species more frequently reported as human pathogens and GenBank accession number of the type strain sequence

GenBank sequences available at http://www.ncbi.nlm.nih.gov/.

Best sequence available for the type strain.

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
Generic image for table
TABLE 4

Species of more frequently reported as human pathogens and GenBank accession number of the type strain sequence

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
Generic image for table
TABLE 5

Species of aerobic actinomycetes other than species infrequently reported or poorly documented as human pathogens and GenBank accession number of the type strain sequence

From J. P. Euzéby (LSPN; www.bacterio.cict.fr); sequences submitted prior to 2000 replaced when possible with similar, more recent sequences.

Previously .

GenBank record X79289 lists the name for this species as strain DSM 43066, the type strain of

Later synonym ; best sequence found for the type strain of .

GenBank record is for strain KACC 20084.

See reference .

Best sequence found for the type strain of .

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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TABLE 6

Species of infrequently reported or poorly documented as human pathogens and GenBank accession number of the type strain sequence

Type strains of these species are known to contain multiple differing copies of the 16S rRNA gene (see text).

Later synonym

B. D. Moser, B. A. Lasker, A. G. Steigerwalt, H. P. Hinrikson, and J. M. Brown, 2009, abstr.Y-019.

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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TABLE 7

Typical in vitro antimicrobial susceptibility patterns of various Nocardia species

From reference . Based on interpretation of MICs, using CLSI breakpoints. Abbreviations: S, susceptible; R, resistant; –, no consistent result.

Includes sensu stricto, , and .

Includes sensu stricto and .

AMC, amoxicillin-clavulanic acid.

MICs of this drug are very low.

Most strains exhibit this pattern.

Interpretation of the 80% inhibition endpoint may be difficult to determine ( ).

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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TABLE 8

Phenotypic characteristics of commonly isolated species known to cause human disease

Adapted from reference . Symbols and abbreviations: –, negative; +, positive; NA, not available; V, variable; W, weak.

Utilization as sole source of carbon and nitrogen.

Utilization as sole source of carbon.

may show opacification of Middlebrook 7H10 or 7H11 agar within 2 to 10 days of incubation at 28 or 35°C ( ).

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