Eighty-six. A gallery of nine conventional and enzymatic tests was developed for the rapid identification of the most common species isolated during this survey. Pyrrolidonyl aminopeptidase, ␥-glutamyl aminopeptidase, ␣-mannosidase, and ␣-glucosidase were found to be highly discriminating and could be used to develop an identification scheme.Nocardia species are isolated with an increased frequency from clinical specimens, especially in specimens from immunocompromised patients (19). The taxonomy of the genus has dramatically been revised during the last decade, and at least 30 valid species have been reported, besides a number of unnamed genomospecies (18). Not all of them have been found in humans, and Nocardia asteroides, previously most frequently isolated from clinical specimens, has proved to be heterogeneous and has been divided into several species (18). More recently, additional species of human origin have been described (6, 8, 9, 11, 12, 17, 28).The routine identification of Nocardia strains at the species level is difficult in the laboratory. This, and the nomenclature changes, may explain that species distribution in clinical isolates has been poorly documented up to now, and even recent surveys still report the "N. asteroides complex" as the most frequent Nocardia species isolated in humans (7,10,16,19). Identification studies have not been systematically carried out since the several recent taxonomic changes.The aim of this study was to assess the species distribution of a large number of Nocardia isolates and to propose simple and rapid identification tests that may be helpful to identify the species most commonly encountered in clinical material.
MATERIALS AND METHODSBacterial strains. Eighty-six Nocardia strains isolated from clinical specimens in Belgium were collected for the study. Most strains were isolated during the past decade, but a few were received before 1990. They were isolated by several laboratories in different parts of the country. All the Nocardia isolates were included in the study to avoid any bias in the selection of the strains. Only one strain per patient was considered. The clinical origins of the isolates were as follows: 36 strains were isolated from the respiratory tract, 18 from pyogenic lesions and wounds, 8 from blood, 4 from brain abscesses, and 1 from cerebral fluid. Nineteen were of unknown origin.The type strains of the most relevant species were included for phenotypic comparison as well as reference strains of some less common species. Nocardia species and strains are listed in Table 1.Sequencing of the 16S rRNA gene. The full-length 16S rRNA gene sequences (Ϯ1,400 nucleotides) of all strains were determined as described previously (24), and sequences were compared to those of the type strains deposited in the GenBank database.Cellular fatty acids were analyzed by gas-liquid chromatography as outlined elsewhere (22).Phenotypic characterization. Strains were cultured on tryptic soy blood agar plates at 35°C. They were examined for partial acid-fastness, presenc...