Infectious diseases now · 2026
Species distribution and antimicrobial susceptibility of Nocardia isolates from patients in Iran with suspected tuberculosis: a two-year study.
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Jaberi Khadijeh, Saghazadeh Mojgan, Sakhaee Fatemeh, Siadat Seyed Davar, Fateh Roohollah, Fateh Abolfazl
Аннотация
INTRODUCTION: While nocardiosis can clinically and radiologically resemble tuberculosis (TB), its frequency and species-specific antimicrobial susceptibility in TB-suspected patients in Iran have yet to be conclusively characterized.
OBJECTIVES: To describe the frequency, species distribution, and in vitro antimicrobial susceptibility of Nocardia isolates retrieved from unique patients investigated for suspected TB at a referral center in Iran from March 2021 to March 2023.
METHODS: We analyzed specimens from 2000 unique patients evaluated for suspected TB. Nocardia species were identified by sequencing 16S rRNA, secA1, and rpoB. was used to assess Amikacin, linezolid, imipenem, amoxicillin-clavulanate, moxifloxacin, and trimethoprim-sulfamethoxazole (TMP-SMX) were assessed using broth microdilution.
RESULTS: Pulmonary TB was identified in 82 patients (4.1%) and TB-Nocardia coinfection in six (10.7%). The most frequent species were N. cyriacigeorgica (20/56, 35.7%), N. farcinica (12/56, 21.4%), and N. asteroides (10/56, 17.9%). Sputum (32/56, 57.1%) and bronchoalveolar lavage (13/56, 23.2%) were the most common specimen sources. Susceptibility to TMP- SMX (56/56, 100%), linezolid (56/56, 100%), and amikacin (52/56, 93%) was highest. Imipenem susceptibility varied by species; 13/56 isolates (23%) were susceptible to moxifloxacin, and 20/56 (36%) to amoxicillin-clavulanate. These are in vitro findings; treatment outcomes were not assessed.
CONCLUSION: In a single-center cohort of patients investigated for suspected TB but without confirmed TB or another mycobacterial infection, Nocardia was detected in 2.5%. Even though species identification and isolate-specific susceptibility testing may help to inform clinical assessment, the findings require validation and do not conclusively establish clinical treatment effectiveness or failure.
OBJECTIVES: To describe the frequency, species distribution, and in vitro antimicrobial susceptibility of Nocardia isolates retrieved from unique patients investigated for suspected TB at a referral center in Iran from March 2021 to March 2023.
METHODS: We analyzed specimens from 2000 unique patients evaluated for suspected TB. Nocardia species were identified by sequencing 16S rRNA, secA1, and rpoB. was used to assess Amikacin, linezolid, imipenem, amoxicillin-clavulanate, moxifloxacin, and trimethoprim-sulfamethoxazole (TMP-SMX) were assessed using broth microdilution.
RESULTS: Pulmonary TB was identified in 82 patients (4.1%) and TB-Nocardia coinfection in six (10.7%). The most frequent species were N. cyriacigeorgica (20/56, 35.7%), N. farcinica (12/56, 21.4%), and N. asteroides (10/56, 17.9%). Sputum (32/56, 57.1%) and bronchoalveolar lavage (13/56, 23.2%) were the most common specimen sources. Susceptibility to TMP- SMX (56/56, 100%), linezolid (56/56, 100%), and amikacin (52/56, 93%) was highest. Imipenem susceptibility varied by species; 13/56 isolates (23%) were susceptible to moxifloxacin, and 20/56 (36%) to amoxicillin-clavulanate. These are in vitro findings; treatment outcomes were not assessed.
CONCLUSION: In a single-center cohort of patients investigated for suspected TB but without confirmed TB or another mycobacterial infection, Nocardia was detected in 2.5%. Even though species identification and isolate-specific susceptibility testing may help to inform clinical assessment, the findings require validation and do not conclusively establish clinical treatment effectiveness or failure.