Brown-Elliott Barbara A, Brown June M, Conville Patricia S, Wallace Richard J
Department of Microbiology, The University of Texas Health Center, 11937 U.S. Highway 271, Tyler, 75708, USA.
Clin Microbiol Rev. 2006 Apr;19(2):259-82. doi: 10.1128/CMR.19.2.259-282.2006.
The recent explosion of newly described species of Nocardia results from the impact in the last decade of newer molecular technology, including PCR restriction enzyme analysis and 16S rRNA sequencing. These molecular techniques have revolutionized the identification of the nocardiae by providing rapid and accurate identification of recognized nocardiae and, at the same time, revealing new species and a number of yet-to-be-described species. There are currently more than 30 species of nocardiae of human clinical significance, with the majority of isolates being N. nova complex, N. abscessus, N. transvalensis complex, N. farcinica, N. asteroides type VI (N. cyriacigeorgica), and N. brasiliensis. These species cause a wide variety of diseases and have variable drug susceptibilities. Accurate identification often requires referral to a reference laboratory with molecular capabilities, as many newer species are genetically distinct from established species yet have few or no distinguishing phenotypic characteristics. Correct identification is important in deciding the clinical relevance of a species and in the clinical management and treatment of patients with nocardial disease. This review characterizes the currently known pathogenic species of Nocardia, including clinical disease, drug susceptibility, and methods of identification.
近期新描述的诺卡菌属物种数量激增，这是过去十年中更新的分子技术，包括聚合酶链反应限制性酶切分析和16S rRNA测序所带来的影响。这些分子技术通过快速准确地鉴定已知的诺卡菌，同时揭示新物种和一些有待描述的物种，彻底改变了诺卡菌的鉴定方法。目前有30多种具有人类临床意义的诺卡菌，大多数分离株为新星诺卡菌复合体、脓肿诺卡菌、跨界诺卡菌复合体、豚鼠耳炎诺卡菌、星状诺卡菌VI型（西里亚乔治亚诺卡菌）和巴西诺卡菌。这些物种可引起多种疾病，且药敏性各不相同。准确鉴定通常需要将样本送至具备分子检测能力的参考实验室，因为许多新物种在基因上与已确定的物种不同，但几乎没有或没有明显的表型特征。正确鉴定对于确定某一物种的临床相关性以及对诺卡菌病患者的临床管理和治疗至关重要。本综述对目前已知的致病性诺卡菌属物种进行了描述，包括临床疾病、药敏性和鉴定方法。
