Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Eur Rev Med Pharmacol Sci. 2021 Jan;25(2):605-608. doi: 10.26355/eurrev_202101_24618.
Nocardia kroppenstedtii was isolated from the spinal vertebral abscess of a 78-year-old patient presenting with mid-thoracic pain and bilateral lower limb weakness and numbness. The patient was on long-term immunosuppressive therapy with steroids for underlying autoimmune hemolytic anemia. Investigations showed a T5 pathological fracture and vertebra plana with the erosion of the superior and inferior endplates. There was evidence of paraspinal collection from the T4-T6 vertebrae with an extension into the spinal canal. Analysis of Nocardia 16S rRNA (99.9%, 1395/1396 nt) and secA1 gene (99.5%, 429/431 nt) fragments showed the highest sequence similarity with Nocardia kroppenstedtii type strain (DQ157924), and next with Nocardia farcinica (Z36936). The patient was treated with intravenous carbapenem and oral trimethoprim-sulfamethoxazole for four weeks, followed by another six months of oral trimethoprim-sulfamethoxazole. Despite the improvement of neurological deficits, the patient required assistive devices to ambulate at discharge. This study reports the first isolation of N. kroppenstedtii from the spinal vertebral abscess of a patient from Asia. Infections caused by N. kroppenstedtii may be underdiagnosed as the bacterium can be misidentified as N. farcinica in the absence of molecular tests in the clinical laboratory.
从一位 78 岁患者的脊柱椎骨脓肿中分离出了 Nocardia kroppenstedtii，该患者表现为中胸疼痛和双侧下肢无力和麻木。该患者因潜在的自身免疫性溶血性贫血而长期接受类固醇免疫抑制治疗。检查显示 T5 病理性骨折和椎体扁平，上、下终板侵蚀。T4-T6 椎体的椎旁有证据表明有收集物，并延伸至椎管。Nocardia 16S rRNA（99.9%，1395/1396 nt）和 secA1 基因（99.5%，429/431 nt）片段分析显示与 Nocardia kroppenstedtii 标准株（DQ157924）的序列相似度最高，其次与 Nocardia farcinica（Z36936）相似。患者接受了四周的静脉用碳青霉烯和口服复方磺胺甲噁唑治疗，然后再口服复方磺胺甲噁唑治疗六个月。尽管神经功能缺损有所改善，但患者在出院时仍需要辅助设备才能行走。本研究报告了首例亚洲患者的脊柱椎骨脓肿中分离出 N. kroppenstedtii。由于在临床实验室中缺乏分子检测，如果不进行分子检测，N. kroppenstedtii 引起的感染可能会被误诊为 N. farcinica。
