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First case of Nocardia cyriacigeorgica septic arthritis in Tunisia

Naija, Habibaa; Chaouch, Cherifaa; Zellama, Dorsafb; Fodha, Imenea; Ketata, Soumayaa

Reviews in Medical Microbiology: July 2014 - Volume 25 - Issue 3 - p 80–83
doi: 10.1097/MRM.0000000000000008
Case Presentations

Nocardia is a Gram-positive, aerobic branched actinomycete; it is a ubiquitous soil saprophyte. Nocardia as a cause of septic arthritis is very unusual. We report a case of Nocardia cyriacigeorgica arthritis in the right knee in a 38-year-old woman who was being treated with systemic corticosteroids for systemic lupus erythematosus and was on haemodialysis. The presumptive bacterial identification of the Nocardia genus was made by Gram and acid-fast staining, growth characteristics, colonial morphology and antibiotic resistance. Identification was later confirmed by PCR and sequence determination of the 16S rRNA gene. The patient was treated successfully with trimethoprim-sulfamethoxazole for 12 months. To the best of our knowledge, this is the first detection of N. cyriacigeorgica in Tunisia and the first Tunisian report of Nocardia arthritis. This finding emphasizes the importance of optimizing conditions of bacterial isolation, especially for immunocompromised patients, to identify less common organisms and initiate early appropriate treatment.

aLaboratory of Bacteriology–Virology

bDepartment of Nephrology, Kidney Transplantation, Sahloul University Hospital, Sousse, Tunisia.

Correspondence to Cherifa Chaouch, Laboratory of Bacteriology–Virology, Sahloul University Hospital, Sousse, Tunisia. Tel: +216 98 830 999; e-mail:

Received 17 March, 2014

Revised 20 April, 2014

Accepted 20 April, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins