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“Nocardia Asteroides.” Nocardia Asteroides - an Overview | ScienceDirect Topics, www.sciencedirect.com/topics/medicine-and-dentistry/nocardia-asteroides.

“16S Ribosomal RNA.” 16S Ribosomal RNA - an Overview | ScienceDirect Topics, www.sciencedirect.com/topics/neuroscience/16s-ribosomal-rna.

Patil, Sharmila P., et al. “Nocardiosis: Clinical and Pathological Aspects.” IntechOpen, IntechOpen, 5 Dec. 2012, www.intechopen.com/books/histopathology-reviews-and-recent-advances/nocardiosis-clinical-and-pathological-aspects.

Schumacher, A, et al. “In Vitro Antimicrobial Susceptibility Testing Methods: Agar Dilution to 3D Tissue-Engineered Models.” European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology, Springer Berlin Heidelberg, Feb. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC5780537/.

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After learning about this case and the steps it took to come to a conclusion of what the issue was, and then a treatment for the problem, I am most looking forward to how microbiology is used when diagnosing patients. It's so interesting to me how it is really is necessary to know the background on the microscopic level of problems so they can then be treated effectively on a larger scale.

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The patient is thankfully recovering well after identification from the tests and the conclusions for what the patient needed for treatment in order to fix the problem.

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The treatment for this patient was to put him on IV Bactrim and Imipenem for 6 weeks that could be found out from the manual broth dilution with the MIC values for those being the lowest. He will also be discharged on oral antibiotics for a year to keep it continuous and stabilized.

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After the multiple tests, it was concluded that the brain abscess having Nocardia farcinica led them to understand it was not lung cancer, but pulmonary nocardiosis. This can be concluded from identifying the specific species, and comparing it to other areas in the body. The chocolate agar also is used for pathogenic bacteria which was proven when Nocardia grew on the media.

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For this case there was a 2+ growth on both forms of media the blood and chocolate agar after 2 days.

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One more test that was done was a Growth on Media test. This is when there is some form of media, such as agar, and the bacteria is swabbed on to the media to later see the results of what sort of colonies grow. For this case blood agar was used and this is something that encourages bacterial growth as it provides a nutrient rich environment for growth. For this case chocolate agar was also used which is a growth medium used for isolation of pathogenic bacteria.

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This test identified that the organism is Nocardia farcinica.

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Another test that was done is 16s sequencing. How this happens is the 16s ribosomal RNA gene codes for the RNA component of the 30s subunit of the bacterial ribosome. It is used to identify bacteria at the species level. It also differentiates between closely related bacteria.

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The results of this test were that the growth pattern was much more evident with the Nocardia asteroides complex which is beneficial as that complex is linked to the brain which explains all of the problems relating to his brain.

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Another test that was done for this patient was looking at the growth on a Nocardia Quad plate. This is a four-sectored plate containing four different media used for differentiation and identification of Nocardia species and other aerobic actinomycetes isolated from clinical specimens.

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After finding the results of the manual broth dilution, the different MIC values were looked at for different antimicrobial's. Whichever values were the lowest, in this case Imipenem and Trimethoprim/Sulfa were used to treat the patient as these were the lowest MIC values.

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One microbiology test that is used is a manual broth dilution. During this method there are tubes containing two fold dilutions of antibiotic agents in liquid growth medium.  With this a specific quantity of bacteria is added to each solution. The solutions then incubate for 24 hours. After the 24 hours the bacterial growth is measured by what amount of the water lost its transparency, also known as turbidity. This then gives the minimum inhibitory concentration. This is a good test as you can gain quantitative MIC values. With these values and information it tells healthcare workers what treatment they need for their patients.

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The patient within this case had symptoms of dizziness, headaches, and walking instability. This is likely linked to Nocardia's tendency to adhere, invade, and grow freely in specific regions of the brain as it is a part of the asteroides complex.

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There are varying degrees of acid fastness, this depends on the mycolic acid composition in the cell wall and what type of stain is used. The kinyoun stain specifically uses 1% sulfuric acid as a decolorizer which helps Nocardia to better retain the color fushion (Patil et al).

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Nocardia is mainly found in richly fertilized soil often found on decaying vegetation.

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Nocardia has braches of bacilli that fragment into rod shaped coccoid, non moving organisms. This creates a beaded appearance.

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Under a light microscope Nocardia can be seen with two different staining methods. It can be seen with a gram stain or a kinyoun stain which is a modified acid fast stain. This bacteria is gram positive.