First Case of Actinomycetoma in France Due to a Novel <i>Nocardia</i> Species, <i>Nocardia boironii</i> sp. nov

Abstract

Bacterial mycetoma is a neglected disease mainly observed in tropical area countries and typically associated with rural conditions, making its presence in developed countries of temperate climate areas rare. However, we report the first case of an autochthonous mycetoma case in continental France that originated from a new <i>Nocardia</i> species. A Gram-positive filamentous bacterium (OFN 14.177^T) was isolated from a pus sample from the mycetoma of a male French patient 92 years old suffering from chronic lymphocytic leukemia. The isolate was analyzed by a polyphasic taxonomic approach by coupling morphological, biochemical, physiological, and chemotaxonomic aspects to genomic and phylogenetic analyses. Multilocus sequence analysis (MLSA) using four housekeeping genes (16S rRNA gene, <i>secA1</i>, <i>hsp65</i>, and <i>sod</i>) combined with phylogenetic analysis revealed that the strain OFN 14.177^T is phylogenetically closer not only to <i>Nocardia altamirensis</i> but also to all other species comprising the <i>Nocardia brasiliensis</i> clade (i.e., <i>N. brasiliensis</i>, <i>N. altamirensis</i>, <i>N. vulneris</i>, <i>N. iowensis</i>, and <i>N. tenerifensis</i>), some of which present cutaneous tropism. The G+C content of isolate OFN 14.177^T was 68.2 mol%. DNA-DNA hybridization analyses demonstrated 38.25% relative reassociation with <i>N. altamirensis</i>. The strain OFN 14.177^T is different from the closest species at genetic and phenotypical levels, and the data obtained indicate that it should be recognized as a new species, for which the name of <i>Nocardia boironii</i> sp. nov. is proposed. The type strain is OFN 14.177^T (= EML 1451 = DSM 101696). <b>IMPORTANCE</b> Bacterial mycetoma is an endemic infection in areas with tropical and subtropical climates. Thus, its presence in temperate climate areas remains rare. We report here the first case of autochthonous actinomycetoma in continental France originating from a <i>Nocardia</i> species other than <i>N. brasiliensis</i>, namely, <i>Nocardia boironii</i>. Considering the history of the patient, the infection source of strain OFN 14.177^T may be from frequent contact with the soil over many years because of his gardening activities. The discovery of a French autochthonous <i>Nocardia</i> species responsible for actinomycetoma reveals the importance of considering the possibility of having autochthonous infections of this type in nontropical countries, not only imported cases from tropical countries. However, further studies are needed to elucidate the real incidence of this new species.