The molecular methodologies used in our laboratories have allowed us to define a group of Nocardia isolates from clinical samples which resemble the type strain of Nocardia veterana. Three patient isolates and the type strain of N. veterana gave identical and distinctive restriction fragment length polymorphisms (RFLPs) for an amplified portion of the 16S rRNA gene. These three isolates and the N. veterana type strain also gave identical RFLPs for an amplified portion of the 65-kDa heat shock protein gene, but this pattern was identical to that obtained for the Nocardia nova type strain. Sequence analysis of both a 1,359-bp region of the 16S rRNA gene and a 441-bp region of the heat shock protein gene of the patient isolates showed 100% identities with the same regions of the N. veterana type strain. DNA-DNA hybridization of the DNA of one of the patient isolates with the DNA of the N. veterana type strain showed a relative binding ratio of 82%, with 0% divergence, confirming that the isolate was N. veterana. Biochemical and susceptibility testing showed no significant differences among the patient isolates and the N. veterana type strain. Significantly, the results of antimicrobial susceptibility testing obtained for our isolates were similar to those obtained for N. nova, indicating that susceptibility testing alone cannot discriminate between these species. We present two case studies which show that N. veterana is a causative agent of pulmonary disease in immunocompromised patients residing in North America. We also describe difficulties encountered in using 16S rRNA gene sequences alone for discrimination of N. veterana from the related species Nocardia africana and N. nova because of the very high degree of 16S rRNA gene similarity among them.Nocardia species have been implicated as the causes of cutaneous, ocular, pulmonary, and disseminated diseases (16) in both immunocompetent and immunocompromised human hosts. Over the past several years the spectrum of disease caused by Nocardia species has changed due to the increase in the number of immunocompromised patients. While cutaneous disease is still the most common presentation in immunocompetent individuals, such infections also occur in the immunocompromised host. However, pulmonary and disseminated infections are the more common presentations in immunocompromised individuals (16).Molecular methodologies have been instrumental in the recognition or description of several new species of Nocardia which have been recognized as human pathogens (11,(23)(24)(25)(30)(31)(32). For several years we have been using such methodologies to identify Nocardia species isolated from clinical specimens. Our procedure involves PCR amplification of portions of both the 16S rRNA gene and the 65-kDa heat shock protein (HSP) gene and subsequent restriction endonuclease analysis (REA) of the PCR products (6,20). Our experience has shown that in most cases, correct species assignment can be made when the identification obtained by REA of the 16S rRNA gene region is identical to ...