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| Year : 1982 | Volume
: 28
| Issue : 3 | Page : 179-80 |
Nocardia brasiliensis-mycetoma--(a case report).
Mohanty PK, Ambekar VA, Deodhar LP, Ranade RR, Mehta VR
How to cite this article:
Mohanty P K, Ambekar V A, Deodhar L P, Ranade R R, Mehta V R. Nocardia brasiliensis-mycetoma--(a case report). J Postgrad Med 1982;28:179 |
The first aerobic actinomycete was discovered by Nocard in 1889 and named by Trevisan as Nocardia farcinica.[4] The Nocardia species are mainly found in soil and are common laboratory contaminants. Nocardia brasiliensis was first isolated from soil in Mexico in 1955, which is a saprophyte.[4] These organisms enter the body through traumatic wounds and start colonisation leading to localised chronic infection. Mycetoma is more common in tropical and subtropical regions.
Very few cases of mycetoma due to Nocardia are reported from India. They are mostly from Madhya Pradesh,[2] Bombay,[3] South India,[5] Andhra[7] and North India.[5] Herewith we are reporting a case of mycetoma of arm due to N. brasiliensis.
A 20 year old female was admitted in the skin ward of L.T.M.G. Hospital with multiple discharging sinuses over the left arm extending upto the left shoulder. She gave a history of injury 1½ years back, over that part. After that, she developed a swelling which was followed by multiple discharging sinuses with serosanguinous material. There was no history of chronic illness like diabetes, tuberculosis or malignancy. The discharging area was of the size of 4" x 3", extending upto the shoulder. Systemic examination of the patient was unremarkable.
Among routine investigations only ESR was raised (80 mm in the 1st hour, Westergreen method). Roentgenograms of the affected area and of the chest were normal. Histological studies of the biopsy from the left shoulder by Haematoxylene and Eosin stain revealed necrotic epidermis with diffuse mixed granuloma consisting of neutrophils, eosinophils and plasma cells.[1], [8] Simultaneously, mycological studies were carried out. Under strict aseptic conditions, two swabs were collected from the discharging sinuses. One swab was used for smear preparation and the other for inoculation in suitable media. Two smears were prepared and one was stained by Gram's staining which revealed Gram positive filamentous bacilli with bacillary and coccobacillary forms and the other stained by Ziehl-Neelsen's staining, using 1% sulphuric acid revealed acid fast filamentous bacilli.[1], [8]
The other swab was inoculated on Sabouraud's dextrose agar slants (with and without chloramphenicol) and incubated at room temperature. 37°C, 46°C and observed daily for growth. Colonies were noticed on the 7th day, which were yellow in colour, wrinkled, heaped and covered with white chalky powder. The Gram staining from the colony showed Gram positive mycelia with bacillary and coccobacillary forms. The acid fast staining, revealed acid fast organisms. Slide culture by Riddel's agar block method was done at room temperature which showed branching mycelia.
Following culture, biochemical studies were carried out. The organism was found to be catalase positive, oxidase negative and non motile. Heavy pellicle formation was seen in thioglycollate broth after 5 days of incubation at room temperature and at 37°C. The organism hydrolysed casein at 37°C, after 72 hours. Heavy growth was obtained in 0.41% gelatin at 30°C after 15 days. It was urease positive, when incubated at 30°C for 2 weeks. The organism could not grow at 46°C after incubation for two weeks.
Based on the above findings, the organism a was identified as Nocardia brasiliensis.
The patient responded well to Doxycycline and the lesion healed subsequently.
Mycetoma is very much common in tropical countries like India; most of them are caused by eumycetes and actinomycetes. The actinomycotic mycetoma varies specieswise from country to country and place to place. The most sensitive method for isolation of the organism is to streak the purulent material directly on suitable media than processing the granule. Mycetoma due to Nocardia brasiliensis is more prevalent in Africa, South America and Mexico. From India, Desai et al[3] and Klokke[5] et al have reported N. brasiliensis mycetoma.
The commonest site of mycetoma is foot, but other sites can be affected as it was in the present study. Desai et al[3] from Bombay reported mycetoma of gluteal region caused by Nocardia. From South India, Reddy et al[7] reported N. asteroides from mycetoma of thigh. The site of mycetoma in the present study is unusual and N. brasiliensis was isolated in pure culture from this site on repeated occasions.
We are thankful to the Dean, L.T.M. Medical College, for allowing us to publish this paper. We also wish to thank Dr. L. N. Mohapatra of A.I.I.M.S., Delhi for confirmation of the species.
| 1. | Chester, W.: Nocardiosis. In, "Medical Mycology." 2nd Edition, Lea and Febiger, Philadelphia, 1970, pp. 94-107.  |
| 2. | Chouhan, S. S. and Agarwal, S.: Histological diagnosis of mycetoma. A clinicopathological study of 24 cases. Ind. J. Med. Res., 57: 71-77, 1969. |
| 3. | Desai, S. C., Pardanani, D. S., Sreedevi, N. and Mehta, R. S.: Studies on mycetoma; Clinical, mycological, histological and radiological studies on 40 cases of mycetoma with a note on its history and epidemiology in India. Ind. J. Surg., 32: 427-447, 1970. |
| 4. | Dey, N. C.: Study of aerobic actinomycetes. In, "Medical Mycology." 2nd Edition, Allied Agency, Calcutta, 1973, pp. 82-93. |
| 5. | Klokke, A. H.: Mycetoma in North India due to Nocardia brasiliensis; First report of Nocardia brasiliensis from Asia. Trop. Geogr. Med., 16: 170-171, 1964. |
| 6. | Klokke, A. H., Swamidasan, G, Anguli, R. and Verghese, N.: The causal agent of mycetoma in South India. Trans. Roy. Soc. Trop. Med. and Hyg., 62: 509-516, 1968. |
| 7. | Reddy, C. R. R. M.. Sundereshwar, B, Ramarao, A. P. and Reddy, S. S.: Mycetoma; Histopathological diagnosis of causal agents in 50 cases. Ind. J. Med. Sci.. 26: 733-737, 1972. |
| 8. | Washington, A. J.: Common aerobic actinomycetes. In. "Laboratory Procedures in Cynical Microbiology". 1st Edition, Springer Verlag, New York, 1981, pp. 395-405. |
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