L-dopa-responsive movement disorder caused by Nocardia asteroides localized in the brains of mice.

Nocardia asteroides can cause infections in the brain of humans and a variety of animals. In mice, invasion of the central nervous system results in specific neurologic signs. Following intravenous injection of various doses of log-phase N. asteroides GUH-2 into female BALB/c mice, localization and growth of nocardial cells within the brains were determined, histopathological sections were prepared, and Nissl substance and tyrosine hydroxylase immunoreactivity were observed. Mice were monitored for the development of neurologic signs, and their responsiveness to L-dopa was determined. It was shown that nocardial cells became localized within specific regions of the brain and then underwent rapid growth followed by a delayed clearance, and there was no inflammatory response at the site of invasion for 24 h. Mice that received a subclinical dose of nocardiae developed specific neurologic signs that emerged following the elimination of nocardial cells from the brain. On the basis of the specific signs, mice could be divided into distinct groups. One group consisted of animals that had a form of hemiparesis that did not respond to L-dopa. They expressed a deviation of the head and a tendency to roll, and when suspended by the tail they would spin rapidly. The second group of mice developed a rhythmic, uncontrolled vertical shake of the head (four to five times per s) tremulous movement, stooped posture, restlessness, and no signs of hemiparesis. The head shakes were temporarily stopped by treatment with L-dopa. Mice that expressed head shakes had a loss of Nissl substance and tyrosine hydroxylase immunoreactivity in the neurons of the substantia nigra and ventral tegmental areas of the brain. Hyaline inclusion bodies that resembled Lewy bodies were found in the neurons of mice with head shake 1 month after infection. Therefore, mice infected with N. asteroides may serve as a model for studying parkinsonian signs and other degenerative diseases involving extrapyramidal and pyramidal systems.     

Nocardia asteroides and Nocardia brasiliensis infections in mice.

A model for Nocardia asteroides and Nocardia brasiliensis infections in Swiss white mice has been established without the addition to the inocula of any form of adjuvant. Serial histopathological studies revealed that these two actinomycetes cause lesions that are quite different in their features. An acute suppurative abscess characterizes the lesions of N. asteroides. In the case of N. brasiliensis infections a granuloma is produced in which a striking feature is the presence of large numbers of foam-laden macrophages, although occasional exceptions to this pattern were noted. Electron microscopic studies demonstrated that these macrophages contain within their cytoplasm organisms in varying stages of degeneration. Repeated mortality studies in mice failed to demonstrate differences in mortality rates produced by N. asteroides and N. brasiliensis. Thus, despite relatively trivial biochemical and antigenic differences between these two species of Nocardia, the local pathogenic response is quite different. The presence in the "brasiliensis lesion" of foamy macrophages with intracellular organisms is reminiscent of the histopathological features of lepromatous leprosy and of disseminated Myocobacterium bovis infection when this occurs in the immune suppressed situation. It is possible that N. brasiliensis infection produces a depression of cellular immunity that modifies the local host response to the organism.     

Monoclonal antibodies to Nocardia asteroides and Nocardia brasiliensis antigens.

Nocardia asteroides and Nocardia brasiliensis whole-cell extracts were used as antigens to generate monoclonal antibodies (MAbs). Six stable hybrid cell lines secreting anti-Nocardia spp. MAbs were obtained. These were characterized by enzyme-linked immunosorbent assay, Western blot (immunoblot), and immunofluorescence assay. Although all the MAbs exhibited different degrees of cross-reactivity with N. asteroides and N. brasiliensis antigens as well as with culture-filtrate antigens from Mycobacteria spp., they have the potential for use as reagents in the purification of Nocardia antigens.     

First report of a brain abscess caused by Nocardia veterana

Among Nocardia species causing infections, Nocardia veterana is rarely isolated and is mostly described as causing pulmonary infections. This is the first presentation of a case of brain abscess attributable to an N. veterana infection in a patient with type 2 diabetes. Prolonged antibiotic therapy with trimethoprim-sulfamethoxazole led to successful clinical recovery.     

Urease-negative Nocardia asteroides causing cutaneous nocardiosis.

We report a case of cutaneous nocardiosis, caused by a urease-negative strain of Nocardia asteroides, in a patient who had undergone long-term corticosteroid therapy. The microbiological characteristics of the isolate were typical of N. asteroides except for the failure of the isolate to hydrolyze urea. During the course of routine identification, laboratory specialists should be aware of the occasional occurrence of atypical strains of N. asteroides.     

Cell-mediated immunity in experimental Nocardia asteroides infection.

Experimental mycetoma-like lesions developed in guinea pigs after subcutaneous injection of Nocardia asteroides. Although delayed hypersensitivity appeared earlier, increased macrophage migration inhibition and microbicidal activity appeared after 7 weeks. When the lesions healed, high cell-mediated immunity was present. Cell-mediated immunity was transferred to normal recipient guinea pigs from healed donor guinea pigs by spleen cell transfer. Recipient guinea pigs showed marked protection against challenge with N. asteroides.     

Mycetoma caused by Nocardia transvalensis.

Nocardia transvalensis can be a rare cause of actinomycotic mycetoma. A 40 year old man presented with his right arm showing multiple discharging sinuses, which had been present for four years. N transvalensis was isolated from a biopsy specimen. No other underlying disease was detected. The patient was successfully managed with surgical excision of the lesion and treatment with co-trimoxazole. This is the first case of N transvalensis infection to be reported from the Indian subcontinent as far as is known.     

DNA probes for the identification of Nocardia asteroides.

DNA probes for the rapid identification of Nocardia asteroides were obtained by constructing a genomic library of strain GUH-2 in the lambda cloning vector EMBL3. Of 50 recombinant clones tested, 2 were identified that hybridized with 31% of the N. asteroides strains in a reference collection without cross-hybridization with related members of the Actinomycetales. Additional libraries were then generated from selected strains of N. asteroides that had failed to hybridize with any of the GUH-2 clones. Four additional clones were obtained from these strains which, when pooled, provided DNA probes specific for all of the N. asteroides strains tested.     

Case report: Nocardia asteroides mycetoma

Primary cutaneous infections with Nocardia asteroides are rare and have been reported in immunocompromised patients. Herein, we report a case of primary cutaneous Nocardia asteroides mycetoma of the skin in an immunocompetent individual. The infection was treated successfully with trimethoprim-sulfamethoxazole. Because a prolonged incubation time is required for the cultures and since additional biochemical tests are necessary for identification of this species, the clinician should alert the microbiology laboratory when such an infection is suspected clinically.     

Virulence of Nocardia asteroides during its growth cycle.

Cells of Nocardia asteroides undergo structural and chemical changes, especially in the cell wall, during growth in brain heart infusion broth. Experiments were devised to determine whether these changes affected the virulence of Nocardia for mice. It took, on the average, 1,380 times the number of colony-forming units at the stationary phase to achieve the same mortality induced by the log-phase cells. Cells in either the lag phase or early stationary phase of growth were intermediate in the numbers of colony forming units required to kill mice. Dry-weight determinations at different stages of growth demonstrated that the log-phase organisms were approximately 10 times heavier than stationary-phase cells. Thus, on the basis of dry-weight (micrograms) values, the average colony-forming unit of log phase is approximately 130 times more virulent than in stationary-phase cultures. Therefore, the stage of growth affects greatly the virulence of N. asteroides.     

Adherence of Nocardia asteroides within the murine brain.

Nonlethal infection of BALB/c mice with Nocardia asteroides GUH-2 (GUH-2) produces a variety of neurological signs, including an L-dopa-responsive movement disorder in 10 to 15% of the infected population. To study nocardial interactions with the brain, we characterized the attachment of GUH-2 within specific regions through the use of microdissection. Following an intravenous injection of a single-cell suspension of log-phase GUH-2, viable cells were recovered from all regions of the brain, and the distribution of the nocardiae was independent of the size of the inoculum. In addition, two mutants of GUH-2 were found to possess significantly altered binding characteristics with regard to both the percentage of the inoculum bound per brain and the relative distribution of adherence to regions of the brain, when compared with the parental strain. These results indicated that GUH-2 bound throughout the murine brain and suggested that GUH-2 utilized specific receptors to facilitate this attachment.     

Experimental infection of chickens with Nocardia asteroides and Nocardia transvalensis

Ten-day-old cockerels were infected with N. asteroides or N. transvalensis by the oral or intraperitoneal routes. Clinical signs included depression, gasping and emaciation. Grey nodules or foci were observed in the lungs, air sacs, liver and breast muscles. These organs showed necrosis, granulomas, lymphoid follicles and infiltration of lymphocytes, heterophils and macrophages. Intraperitoneal infection resulted in a more severe disease with either organism. N. transvalensis appeared more pathogenic than N. asteroides intraperitoneally and vice versa with the oral route.     

Cell-mediated immunity to Nocardia asteroides induced by its ribonucleic acid protein fraction.

Guinea pigs immunized with ribonucleic acid protein fraction from Nocardia asteroides developed high cell-mediated immunity within 2 weeks, as shown by increased macrophage microbicidal activity and macrophage migration inhibition. This immunity protected against intravenous and subcutaneous challenge with N. asteroides and persisted for at least 70 days.     

Method for improved extraction of DNA from Nocardia asteroides.

In a variation of standard DNA extraction methods, Nocardia asteroides was repeatedly exposed to sodium dodecyl sulfate at 60 degrees C for 30 min; each extraction was followed by centrifugation, removal of the nucleic acid-rich supernatant, and suspension of the cell pellet in fresh sodium dodecyl sulfate. The pooled supernatants contained a substantially higher amount of DNA than the first supernatant alone. The possible implications of this procedure on the development of DNA probes are discussed.     

Site-specific growth of Nocardia asteroides in the murine brain.

The growth of Nocardia asteroides GUH-2 and two mutants (NG-49 and I-38-syn) in regions of the brains of BALB/c mice was determined by microdissection and viable counting. GUH-2 grew throughout the murine brain but at different growth rates that depended on the specific location. The rate of increase in total CFU per brain during GUH-2 infection was unaffected by the inoculum size; however, in five of eight brain regions, an alteration in the inoculum size resulted in altered nocardial growth rates. Mutant NG-49 showed a significantly slower rate of increase in total CFU per brain than did the parental strain, GUH-2, and significantly decreased growth rates in seven brain regions. Mutant I-38-syn showed a rate of increase in total CFU per brain similar to that of the parental strain; however, this mutant grew significantly faster in the cerebellum and pons-medulla. Growth appeared to be a necessary precursor to the cellular damage that resulted in the variety of neurological disorders observed in mice infected with N. asteroides GUH-2, because mutant NG-49 exhibited a decreased ability to grow in specific regions of the brain and did not induce signs of neurological damage. In contrast, mutant I-38-syn induced neurological signs in a larger percentage of the infected animals than did parental strain GUH-2 and grew better in certain regions of the brain than did the parental strain. Furthermore, there appeared to be a relationship between the growth of N. asteroides in the substantia nigra and the induction of an L-dopa-responsive head shake that was observed in some of the mice following a sublethal intravenous injection of N. asteroides GUH-2.     

Interaction of Nocardia asteroides with cultured rabbit alveolar macrophages.

The interaction between virulent and less virulent strains of Nocardia asteroides and cultured rabbit alveolar macrophages was studied. It was shown that cells of the less virulent strain (N. asteroides 10905) were rapidly phagocytized and destroyed. However, some cells were able to avoid being killed, and they persisted within the macrophage in an altered, gram-negative form. These variants apparently increased in numbers after several days within the macrophage population, so that at 9 days postinfection more colony-forming units per macrophage were recovered than at 3 h. Little or no extracellular growth was observed in the tissue culture medium. During the increase at 9 days, both transitional-phase variants and L-forms of N. asteroides were isolated from the macrophages but not from the medium. Gram-positive bacterial cells were never observed in 9-day infected macrophages. In contrast, cells of the more virulent strain (N. asteroides 14759) were not destroyed after being ingested. After 6 h postinfection, it was observed that the number of colony-forming units per macrophage had increased significantly. There was no corresponding increase in extracellular organisms observed in the culture medium. Therefore, cells of N. asteroides 14759 were able to grow rapidly within cultured rabbit alveolar macrophages. Upon continued incubation of the infected cells (24 h postinfection), it was shown that this strain of Nocardia grew out of the macrophages as acid-fast branching filaments. From these data, it is clear that the initial interaction between N. asteroides and unstimulated, nonimmune alveolar macrophages depends upon the relative virulence of the nocardial strain.