DISSEMINATED NOCARDIA-ASTEROIDES DIAGNOSED BY BLOOD CULTURE IN A PATIENT WITH DISSEMINATED HISTOPLASMOSIS

We describe herein a provocative case involving an immunosuppressed patient with disseminated Histoplasma capsulatum and also disseminated Nocardia asteroides, which was documented by multiple routine blood culture samples. Nocardia asteroides was isolated from 15 routine blood cultures using the nonradiometric blood culture system (Bactec NR-660, Becton Dickinson, Towson, Md). Several different species of the genus Nocardia proved to thrive in blood culture bottles (Bactec) when experimental inoculations were performed. The paucity of reports in the literature of disseminated nocardiosis with positive blood cultures has led us to consider cause for the apparent poor recovery of these organisms from blood culture media. We suggest that the media (Bactec) can successfully support growth of Nocardia species and that other variables, such as incubation times and subculture, should be considered to optimize isolation of this pathogen in blood culture systems.