NAME: Nocardia spp.
SYNONYM OR CROSS REFERENCE: Nocardia asteroides, N. brasiliensis, N. caviae, N. transvalensis, N. ottidiscaviarum, Nocardiosis
CHARACTERISTICS: Order Actinomycetales; exhibits classical fungal characteristics, but presence of peptidoglycans in the cell wall allows classification as higher bacterium; aerobic; thin, gram positive branching filaments; may fragment into bacillary or coccoid forms; soil saprophyte
PATHOGENICITY: Chronic disease originating in lungs; pulmonary alveolar proteinosis predisposes individual for infection; 80% of cases present as invasive pulmonary infection; 10% of pulmonary disorders are fatal; symptoms include fever, cough, chest pain, CNS disease, headache, lethargy, confusion, seizures, sudden onset of neurologic deficit, 20% of patients develop granulomatous, skin lesions and CNS abnormalities; spread to blood - abscesses of brain, subcutaneous tissue and other organs; fatality rate can be high; also causes mycetoma (swelling and suppuration of subcutaneous tissues and formation of sinus tracts with visible granules, lesions usually on foot or lower leg)
EPIDEMIOLOGY: Nocardiosis - occasional sporadic disease worldwide; Mycetoma - Mexico, North Africa, South Asia and other tropical and subtropical areas; no evidence of age or racial differences; ratio of male/female ratio for infection is 2:1
HOST RANGE: Humans, animals
INFECTIOUS DOSE: Unknown
MODE OF TRANSMISSION: Nocardiosis - Inhalation of contaminated dust; Mycetoma - subcutaneous contamination by a penetrating wound (thorns, splinters); rarely nosocomial post surgical transmission occurs
INCUBATION PERIOD: Uncertain; months for mycetoma
COMMUNICABILITY: Not directly transmitted from person-to-person
RESERVOIR: Soil, decaying vegetation
ZOONOSIS: None
VECTORS: None
DRUG SUSCEPTIBILITY: Sensitive to sulfonamides (TMP-SMX, sulfisoxazole, sulfadiazine)
SUSCEPTIBILITY TO DISINFECTANTS: Susceptible to 1% sodium hypochlorite 2% glutaraldehyde, formaldehyde; susceptibility to 70% ethanol questionable (phenolics may be substituted)
PHYSICAL INACTIVATION: Inactivated by moist heat (121° C for at least 15 min) and dry heat 160-170° C for at least 1 hour
SURVIVAL OUTSIDE HOST: Saprophyte - survives out of host in soil, decaying matter
SURVEILLANCE: Monitor for symptoms; visualization and isolation of the organism
FIRST AID/TREATMENT: Surgical drainage may be required; antimicrobial therapy should be administered as required
IMMUNIZATION: None
PROPHYLAXIS: None
LABORATORY-ACQUIRED INFECTIONS: 1 reported laboratory acquired infection with Nocardia
SOURCES/SPECIMENS: Sputum, pus, CSF, bronchial washings, rarely isolated from blood
PRIMARY HAZARDS: Accidental parenteral inoculation, exposure of the mucous membranes to droplets and aerosols, ingestion
SPECIAL HAZARDS: None
CONTAINMENT REQUIREMENTS: Biosafety level 2 practices, containment equipment and facilities for all activities involving the manipulation of this organism
PROTECTIVE CLOTHING: Laboratory coat; gloves when direct contact with infectious materials is unavoidable
OTHER PRECAUTIONS: None
SPILLS: Allow aerosols to settle; wearing protective clothing, gently cover spill with absorbent paper towel and apply 1% sodium hypochlorite, starting at perimeter and working towards the centre; allow sufficient contact time (30 min) before clean up
DISPOSAL: Decontaminate before disposal; steam sterilization, chemical disinfection, incineration
STORAGE: In sealed containers that are appropriately labelled
Date prepared: March, 2001
Prepared by: Office of Laboratory Security, PHAC
Although the information, opinions and recommendations contained in this Material 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 ©
Health Canada, 2001
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