Original Article PULMONARY NOCARDIOSIS ASSOCIATED WITH CUSHING’S SYNDROME

Nocardia species consists of strict aerobic bacilli that form branched hyphae in both tissues and culture. Infection with Nocardia is an uncommon but important cause of morbidity and mortality in immunocompromised patients and organ transplant recipients. Since Nocardia species have been isolated from the soil of different regions of Iran, as well as different cases of Nocardiosis, this study was undertaken to evaluate the role and frequency of Nocardia in pulmonary infections in the country. The present study was planned to isolate Nocardia bacteria from immunocompromised patients who had been referred to Maseeh-e-Daneshvari Training Hospital (Tehran). 142 patients with advanced symptomatic pulmonary disease were studied during a period of seven months. Of all the patients surveyed 102 were tested both for their BAL (bronchoalveolar lavage) and sputum. For the rest of the patients sputum samples were not accessible. From each sample three thin smears were prepared for microscopic observations. The samples were cultured in Sabouraud dextrose agar and paraffin agar. Medical histories of patients were also recorded in the certain questionnaire for further data analysis. Nocardia asteroids was isolated from only a patient suffering from Cushings syndrome with bronchogenic carcinoma {Ectopic adrenocorticotrophic hormone (ACTH) syndrome}. Further in-vitro investigation for differentiation the isolate was performed and confirmed that the organism grew on primary media was Nocardia steroids complex. Results revealed that the normal concentration of NaOH (4%), which is routinely being used for identification of Mycobacteria species, could inhibit the growth of Nocardia. Therefore, decontamination procedure of the samples collected for isolation of Nocardia was performed using 1% NaOH in this study