NOCARDIA

PATHOGEN SAFETY DATA SHEET - INFECTIOUS SUBSTANCES

SECTION I - INFECTIOUS AGENT

NAME: Nocardia spp.

SYNONYM OR CROSS REFERENCE: Nocardiosis, N. cyriacigeorgica, N. farcinica, N. abscessus, N. asteroides, N. brasiliensis, N. nova, N. otitidiscaviarum, N. paucivorans, N. pseudobrasiliensis, N. transvalensis, N. veterana and N. wallacei are the most frequently reported pathogens from this genus. Rare or infrequent pathogens include: N. africana, N. anaemiae, N. araoensis, N. arthritidis, N. asiatica, N. beijingensis, N. blacklockiae, N.brevicatena, N. carnea, N. concavca, N. corynebacteroides, N. elegans, N. exalbida, N. higoensis, N. ignorata, and N. inohanensis⁽¹⁾ .

CHARACTERISTICS: Nocardia are actinomycetes and there are over 70 species in the genus, of which ~ 25 species are pathogenic to humans⁽²⁾. They are gram positive aerobic bacteria that are 0.5-1.0 μm in diameter with branched vegetative hyphae that split into pleomorphic rods and cocci^(2,3,4).

SECTION II - HAZARD IDENTIFICATION

PATHOGENICITY/TOXICITY: Nocardial infections are predominantly opportunistic infections. As such, patients who are immunosuppressed (transplant patients and patients with HIV, systematic lupus erythematosis, chronic granulomatous disease, malignancies, trauma, or intravenous catheters) are at higher risk of contracting nocardiosis^(2,3). Nocardial infections occur in three main forms: pulmonary, systemic, and cutaneous^(3,4). Pulmonary infections usually cause acute, chronic, or relapsing bronchopneumonia that sometimes spreads to cavities and pleura⁽³⁾. Symptoms include coughing, dyspnea, and fever. Pulmonary infection can lead to systemic or neurologic complications such as meningitis and brain abscesses^(2,3). Nocardia brain abscesses are commonly found in the brain stem, basal ganglia, and cerebral cortex⁽⁵⁾, and the mortality rate for patients who develop brain abscesses is about 50%⁽⁶⁾. Systemic infections of Norcardia are rare and commonly occur in immunocompromised individuals⁽⁷⁾. Cutaneous infection, called mycetoma, is characterized by pustules, fever, tender lymphadenitis in local lymph nodes, abscess, and yellow-white grainy discharge^(3,8). Mycetoma can affect the underlying bone and is most common in adult males who walk bare foot or who have burn injuries⁽⁸⁾. With appropriate antibiotic treatment, it is usually healed within a few weeks, though it may take up to 3 months for full clearance⁽⁸⁾.

EPIDEMIOLOGY: Nocardia have a worldwide distribution as they are commonly present in the environment and soil; however, certain species are more common in specific geographic areas^(2,3,6). N. cyriacigeorgica, N. farcinica, and N. nova are often found in non-tropical countries whereas N. brasiliensis is found in tropical and subtropical climates of America and N. otitidiscaviarum is found in the US, India, Japan, and Tunisia^(2,4,6). Cases are sporadic with a majority of cases occurring in people between the ages of 21 and 50 years old, with a male/female ratio of 3:1⁽⁶⁾.

HOST RANGE: Humans and a variety of animals (cattle, cats, dogs, chickens, ducks, fish, goats, sheep and swine) have been shown to carry the bacterium⁽⁴⁾.

INFECTIOUS DOSE: Unknown

MODE OF TRANSMISSION: The pulmonary form is caused by inhalation of the bacteria in dust whereas the cutaneous form is caused by inoculation (for example thorn prick, cat scratch or insect bite)^(2,3). Nosocomial infections have been reported^(2,4).

INCUBATION PERIOD: Unknown⁽⁶⁾

COMMUNICABILITY: The bacterium is not transmitted from human-to-human but rather through contact with it in the environment⁽³⁾.

SECTION III - DISSEMINATION

RESERVOIR: Soil, decaying vegetation, sewage sludge, water, and plant and animal (including human) tissues are the reservoir for the bacterium^(3,4,8).

ZOONOSIS: None⁽⁶⁾.

VECTORS: None.

SECTION IV - STABILITY AND VIABILITY

DRUG SUSCEPTIBILITY: Most species are susceptible to trimethoprim-sulfamethoxazole, amikacin, ampicillin, carbenicillin, broad-spectrum cephalosporins, minocycline, erythromycin, ciprofloxacin, clindamycin, imipenem, and cotrimoxazol, but resistant to penicillin and antituberculous, and antifungal agents^(3,4,8).

SUSCEPTIBILITY TO DISINFECTANTS: Susceptible to 2-5% phenol, 1% sodium hypochlorite, 4% formaldehyde, 2% glutaraldehyde, 70% ethanol, 70% propanol, 2% peracetic acid, 3-6% hydrogen peroxide, and iodine⁽⁹⁾.

PHYSICAL INACTIVATION: Bacteria are susceptible to moist heat (121 *C for at least 15 minutes) and dry heat (160-170 *C for at least 1 hour)⁽¹⁰⁾. It is able to remain viable for 8 hours at 50 *C⁽⁴⁾.

SURVIVAL OUTSIDE HOST: Nocardia are saprophytes and survive in soil and decaying vegetal matter^(4,8).

SECTION V - FIRST AID / MEDICAL

SURVEILLANCE: Monitor for symptoms. ELISA for detection of Nocardia -specific mAbs, PCR, sequence-based identification methods, and microscopic observation can be used to identify the presence of species in the host^(2,4,11,12).

Note: All diagnostic methods are not necessarily available in all countries.

FIRST AID/TREATMENT: Appropriate antibiotic therapy is used to treat clinical disease caused by this bacterium^(3,8). In some cases of mycetoma, surgical drainage may be needed⁽⁸⁾.

IMMUNISATION: None.

PROPHYLAXIS: None.

SECTION VI - LABORATORY HAZARDS

LABORATORY-ACQUIRED INFECTIONS: None reported to date

SOURCES/SPECIMENS: Nocardia have been isolated from sputum, sinus tissues, bronchial aspirates, pus, and rarely from urine and blood^(3,13).

PRIMARY HAZARDS: Primary are mucocutaneous contact with the infective agent, accidental parenteral inoculation, and aerosol exposure⁽¹⁴⁾.

SPECIAL HAZARDS: None

SECTION VII - EXPOSURE CONTROLS / PERSONAL PROTECTION

RISK GROUP CLASSIFICATION: Risk group 2⁽¹⁵⁾. This risk group classification applies to the genus as a whole, and may not reflect the risk group classification of every species within the genus.

CONTAINMENT REQUIREMENTS: Containment Level 2 facilities, equipment, and operational practices for work involving infected or potentially infected materials, animals, or cultures.

PROTECTIVE CLOTHING: Lab coat. Gloves when direct skin contact with infected materials or animals is unavoidable. Eye protection must be used where there is a known or potential risk of exposure to splashes⁽¹⁶⁾.

OTHER PRECAUTIONS: All procedures that may produce aerosols, or involve high concentrations or large volumes should be conducted in a biological safety cabinet (BSC). The use of needles, syringes, and other sharp objects should be strictly limited. Additional precautions should be considered with work involving animals or large scale activities⁽¹⁶⁾.

SECTION VIII - HANDLING AND STORAGE

SPILLS: Allow aerosols to settle, then, wearing protective clothing, gently cover the spill with absorbent paper towel and apply appropriate disinfectant, starting at the perimeter and working towards the center. Allow sufficient contact time before starting the clean up⁽¹⁶⁾.

DISPOSAL: All wastes should be decontaminated before disposal either by steam sterilization, incineration or chemical disinfection⁽¹⁶⁾.

STORAGE: The infectious agent should be stored in a sealed and identified container⁽¹⁶⁾.

SECTION IX - REGULATORY AND OTHER INFORMATION

REGULATORY INFORMATION: The import, transport, and use of pathogens in Canada is regulated under many regulatory bodies, including the Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Environment Canada, and Transport Canada. Users are responsible for ensuring they are compliant with all relevant acts, regulations, guidelines, and standards.

UPDATED: November 2010

PREPARED BY: Pathogen Regulation Directorate, Public Health Agency of Canada.

Although the information, opinions and recommendations contained in this Pathogen Safety Data Sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date.

Copyright ©
Public Health Agency of Canada, 2010
Canada

REFERENCES:

1. Euzéby, J. P. (2010). List of Prokaryotic Names with Standing in Nomeclature. Retrieved 10/18, 2010, from www.bacterio.cict.fr/
2. Murray, P. R., Baron, E. J., Jorgensen, J. H., Landry, M. L., & Pfaller, M. A. (Eds.). (2007). Manual of Clinical Microbiology (9th ed.). Washington: ASM Press.
3. Ryan, K. J., & Ray, C. G. (Eds.). (2004.). Sherris Medical Microbiology: An Introduction to Infectious Disease. (Fourth Edition. ed.). New York.: McGraw-Hill.
4. Goodfellow, M. (1998). Nocardia and Related Genera. In A. Balows, & B. I. Duerden (Eds.), Topley and Wilson's Microbiology and Microbial Infections (pp. 463). London: Arnold.
5. Marnet, D., Brasme, L., Peruzzi, P., Bazin, A., Diallo, R., Servettaz, A., Bernard, M. H., Rousseaux, P., de Champs, C., Jaussaud, R., & Scherpereel, B. (2009). Nocardia brain abscess: features, therapeutic strategies and outcome. [Abces cerebraux aNocardia: caracteristiques radiocliniques et prise en charge therapeutique] Revue Neurologique, 165 (1), 52-62. doi:10.1016/j.neurol.2008.06.012
6. Acha, P. N., & Szyfres, B. (2003). Zoonoses and Communicable Diseases Common to Man and Animals (3rd ed., ). Washington, D.C.: Pan American Health Organization.
7. Feng, Y. H., Huang, W. T., & Tsao, C. J. (2004). Venous access port-related nocardia bacteremia with successful short-term antibiotics treatment. Journal of the Chinese Medical Association : JCMA, 67 (8), 416-418.
8. Inamadar, A. C., & Palit, A. (2003). Primary cutaneous nocardiosis: a case study and review. Indian Journal of Dermatology, Venereology and Leprology, 69 (6), 386-391.
9. Collins, C. H., & Kennedy, D. A. (1999). Laboratory acquired infections. Laboratory acquired infections: History, incidence, causes and prevention (4th ed., pp. 1-37). Woburn, MA: BH.
10. Joslyn, L. J. (2001). Sterilization by Heat. In S. S. Block (Ed.), Disinfection, Sterilization, and Preservation (5th ed., pp. 695). Philadelphia: Lippincott Williams & Wilkins.
11. Jimenez, T., Diaz, A. M., & Zlotnik, H. (1990). Monoclonal antibodies to Nocardia asteroides and Nocardia brasiliensis antigens. Journal of Clinical Microbiology, 28 (1), 87-91.
12. Xiao, M., Kong, F., Sorrell, T. C., Cao, Y., Lee, O. C., Liu, Y., Sintchenko, V., & Chen, S. C. (2010). Identification of pathogenic Nocardia species by reverse line blot hybridization targeting the 16S rRNA and 16S-23S rRNA gene spacer regions. Journal of Clinical Microbiology, 48 (2), 503-511. doi:10.1128/JCM.01761-09
13. Torres, O. H., Domingo, P., Pericas, R., Boiron, P., Montiel, J. A., & Vazquez, G. (2000). Infection caused by Nocardia farcinica: case report and review. European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology, 19 (3), 205-212.
14. Richmond, J. Y., & McKinney, R. W. (Eds.). (2007). Biosafety in Microbiological and Biomedical Laboratories (BMBL) (5th ed.). Washington, D.C.: Centers for Disease Control and Prevention.
15. Human Pathogens and Toxins Act. S.C. 2009, c. 24. Government of Canada, Second Session, Fortieth Parliament, 57-58 Elizabeth II, 2009, (2009).
16. Public Health Agency of Canada. (2004). In Best M., Graham M. L., Leitner R., Ouellette M. and Ugwu K. (Eds.), Laboratory Biosafety Guidelines (3rd ed.). Canada: Public Health Agency of Canada.