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Journal of Clinical Microbiology, June 2003, p. 2560-2568, Vol. 41, No. 6
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.6.2560-2568.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Nocardia veterana as a Pathogen in North American Patients

Patricia S. Conville,^1* June M. Brown,² Arnold G. Steigerwalt,² Judy W. Lee,^1, Dorothy E. Byrer,^3, Victoria L. Anderson,⁴ Susan E. Dorman,^4, Steven M. Holland,⁴ Barbara Cahill,⁵ Karen C. Carroll,^6,|| and Frank G. Witebsky¹

Microbiology Service, Department of Laboratory Medicine, Warren G. Magnuson Clinical Center,¹ Laboratory of Host Defenses, National Institute of Allergy and Infectious Diseases, National Institutes of Health, U.S. Department of HealthHuman Services, Bethesda, Maryland,⁴ Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, Georgia,² American Type Culture Collection, Manassas, Virginia,³ Division of Pulmonary and Critical Care Medicine, University of Utah School of Medicine,⁵ Department of Pathology, University of Utah, Salt Lake City, Utah⁶

Received 27 January 2003/ Returned for modification 14 February 2003/ Accepted 24 February 2003

The molecular methodologies used in our laboratories have allowed us to define a group of Nocardia isolates from clinical samples which resemble the type strain of Nocardia veterana. Three patient isolates and the type strain of N. veterana gave identical and distinctive restriction fragment length polymorphisms (RFLPs) for an amplified portion of the 16S rRNA gene. These three isolates and the N. veterana type strain also gave identical RFLPs for an amplified portion of the 65-kDa heat shock protein gene, but this pattern was identical to that obtained for the Nocardia nova type strain. Sequence analysis of both a 1,359-bp region of the 16S rRNA gene and a 441-bp region of the heat shock protein gene of the patient isolates showed 100% identities with the same regions of the N. veterana type strain. DNA-DNA hybridization of the DNA of one of the patient isolates with the DNA of the N. veterana type strain showed a relative binding ratio of 82%, with 0% divergence, confirming that the isolate was N. veterana. Biochemical and susceptibility testing showed no significant differences among the patient isolates and the N. veterana type strain. Significantly, the results of antimicrobial susceptibility testing obtained for our isolates were similar to those obtained for N. nova, indicating that susceptibility testing alone cannot discriminate between these species. We present two case studies which show that N. veterana is a causative agent of pulmonary disease in immunocompromised patients residing in North America. We also describe difficulties encountered in using 16S rRNA gene sequences alone for discrimination of N. veterana from the related species Nocardia africana and N. nova because of the very high degree of 16S rRNA gene similarity among them.

Present address: Northwestern University, Feinberg School of Medicine, Chicago, Ill.

Present address: Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, Ga.

Present address: Johns Hopkins Center for Tuberculosis Research, Johns Hopkins Medical Institutions, Baltimore, Md.

^|| Present address: Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Md.

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