Nocardia – Aerobic Actinomycetes
Consistent with O. Reg. 671/92 of the French Language Services Act, laboratory testing information on this page is only available in English because it is scientific or technical in nature and is for use only by qualified health care providers and not by members of the public.
Background
This page provides testing information for culture and identification of Nocardia spp. and Aerobic Actinomycetes grown from clinical specimens submitted to Public Health Ontario (PHO).
For information regarding other mycology-related testing options, please refer to the following PHO webpages:
- Fungal Culture – Superficial
- Pneumocystis jirovecii (PJP) detection
- Reference Identification of Yeasts, Filamentous Fungi and Nocardia/Aerobic Actinomycetes
- Antifungal Susceptibility Testing of Yeasts and Filamentous Fungi
- Antimicrobial Sensitivity Testing of Nocardia spp. and Aerobic Actinomycetes
A separate specimen and corresponding requisition is required for Mycology testing, see special instruction.
Testing Indications
To establish the presence of Nocardia spp. or other Aerobic Actinomycetes pathogen from clinical specimens. Appropriate specimens should be collected when these organisms are being considered as the causative agent of infection.
Acceptance/Rejection Criteria
Specimens will be subject to rejection/cancellation under the following circumstances:
- Specimen submitted as one specimen/one requisition with requests for multiple test types
- Requests for Nocardia spp./Aerobic Actinomycetes culture may be submitted using the same specimen and requisition submitted for systemic fungal culture and/or Pneumocystis microscopy.
- Specimens that have leaked in transit
- Improperly collected eg. specimen in virus transport medium (VTM), formalin or other universal transport medium (UTM)
- Swabs are not accepted for culture.
Specimen Requirements
| Test Requested | Required Requisition(s) | Specimen Type | Minimum Volume | Collection Kit |
Nocardia spp. culture |
Bronchial washings, sputum, bronchial alveolar lavage, abscesses, tissue |
Sufficient specimen must be received for both culture and microscopy to be performed. If insufficient specimen is received, culture only will be done |
Sterile container |
|
Aerobic actinomycetes culture |
Bronchial washings, sputum, bronchial alveolar lavage, abscesses, tissue |
Sufficient specimen must be received for both culture and microscopy to be performed. If insufficient specimen is received, culture only will be done |
Sterile container |
Submission and Collection Notes
Complete all fields of the requisition form, fields a-e are mandatory.
- Test(s) requests and indications for testing
- Specimen source (with details)
- Collection date and time
- Patient setting (eg. out-patient, in-patient, ICU, burn ward etc) - VERY important to note on the requisition
- Immune status – VERY important to note on the requisition if patient has had a transplant, has a haematological malignancy, or is otherwise immunocompromised (including burn wounds, diabetes etc) as this will impact work up and reporting practices
- Current antifungal therapy and/or clinical diagnosis.
- Requests for specific organisms of concern (dimorphics, Aspergillus spp., Fusarium spp., Malassezia spp.)
- Any available direct microscopic exam results from submitting lab
For clinical specimens, label the specimen container(s) with the patient’s first and last name, date of collection, and one other unique identifier such as the patient’s date of birth or Health Card Number. For additional information see: Criteria for Acceptance of Patient Specimens. Failure to provide this information may result in rejection or testing delay.
Whenever planning to submit a specimen for mycology and non-mycology tests, always submit a separate specimen and requisition for mycology testing (i.e. if fungal culture and TB or Legionella culture are to be requested, separate specimens and requisitions should be submitted for each), otherwise it can lead to delay of testing or testing not performed due to insufficient volume of specimen.
Timing of Specimen Collection
Please submit a maximum of 1 specimen per patient, per site, per day if necessary. Submitting more than one specimen per site may result in specimens being pooled, or later specimens being referred to earlier results.
Storage and Transport
Store bronchial washings, sputum, bronchoalveolar lavage (BAL) and abscess specimens at 2-8°C following collection and ship to PHO’s laboratory ASAP.
Store tissue specimens at room temperature following collection and ship to PHO’s laboratory ASAP.
All clinical specimens must be shipped in accordance to the Transportation of Dangerous Good Act.
Special Instructions
- Always submit a separate specimen and corresponding requisition for Mycology testing to avoid delay or tests not able to be performed. If there are other non-Mycology tests to be requested for that same specimen for mycology testing, submit a specimen in a separate container with corresponding requisition for Mycology testing.
- Requests for Nocardia spp./Aerobic Actinomycetes culture, and/or fungal culture and/or Pneumocystis microscopy may be submitted using the same specimen and requisition.
- Susceptibility testing for Nocardia spp. (and aerobic actinomycetes) will be performed by broth micro dilution assay by request only.
Test Frequency and Turnaround Time (TAT)
Nocardia spp. and Aerobic Actinomycetes culture is done daily, Monday to Friday at PHO’s Toronto and Thunder Bay Laboratory.
Turnaround Time for microscopy: 2 business days from receipt at PHO Laboratory
Turnaround Time for culture report: 10 business days (2 weeks) from receipt at PHO Laboratory
Turnaround Time for Identification of isolates: most within 5 -10 days.
All specimens submitted for Nocardia spp./Aerobic Actinomycetes culture automatically include a direct microscopic exam, routine (systemic) fungal culture. Nocardia spp. or Aerobic Actinomycetes gown in culture will be subject to a full identification.
Microscopic exam uses Fungi-Fluor® and/or Calcofluor white stain.
Calcofluor white is a non-specific fluorochrome that binds to the chitin in the cell wall of fungi and fluoresces blue-white under ultraviolet microscopy.
Nocardia and Aerobic actinomycetes culture identification uses various conventional methods, including microscopic morphology, growth temperature and culture characteristics. Molecular methods such as sequencing and matrix-assisted laser desorption/ionization – time of flight mass spectrometry (MALDI-TOF MS) will be used when needed.
Interpretation
The following table provides possible test results with associated interpretations:
Microscopic Result |
Interpretation |
Final Report |
|---|---|---|
No fungal elements seen |
Nocardia/Aerobic actinomycetes not seen in direct exam. |
No Aerobic actinomycetes isolated. Identification to genus/species level if recovered in culture. |
Thin, branching filaments resembling Aerobic actinomycetes |
Organism resembling Nocardia/Aerobic actinomycetes was seen in the direct exam. |
Identification to genus/species if recovered in culture. |
Reporting
Results are reported to the physician, authorized health care provider (General O. Reg 45/22, s.18) or submitter as indicated on the requisition.
References
- Clinical and Laboratory Standards Institute (CLSI). Principles and Procedures for Detection and Culture of Fungi in Clinical Specimens. 2nd ed. CLSI guideline M54 (ISBN 978-1-68440-098-0 {Print}; ISBN 978-1-68440-099-7 {Electronic}). Clinical and Laboratory Standards Institute; 2021
- Hazen, K., Howell, S.A.. Mycology and antifungal susceptibility testing. In: Leber, A.M. Editor. Clinical Microbiology Procedures Handbook. 4th ed. Washington, D.C.; ASM Press; 2016.
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