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Nocardia is a strictly aerobic gram-positive, partially acid-fast mycelial bacterium that superficially resembles the fungus (Beaman & Beaman, 1994). The bacterium causes Ldopa-responsive movement disorder accompanied by neuronal inclusions resembling Lewy bodies, suggesting a possible link between Nocardia and Parkinson’s disease (PD) (Kohbata & Beaman, 1991). PD is a slowly progressive, acute monophasic neurological disorder with a lengthy prodromal phase before the onset and with longer duration of disease (Fearnley & Lees, 1991; Hawkes, 2008). It is characterized pathologically by neuronal loss, reactive gliosis, and Lewy bodies in the remaining neurons in the midbrain substantia nigra (Greenfield & Bosanquet, 1953). Spread of Lewy bodies occurs from the brainstem through midbrain and basal forebrain to the cerebral cortex (Braak et al., 2003). Furthermore, the transfer of the nigral lesion to fetal grafts in PD patients with fetal nigral transplantation happens (Braak & Tredici, 2008; Li, et al., 2008). The transfer experiment of the nigral lesion to experimental animals did not attain satisfactory results by using antibiotic-containing homogenizing buffer (Bethlem & Jager, 1960). PD is probably caused by an environmental agent rather than a hereditary factor. The environmental agent may be parasitic to midbrain nigral tissues and bacterial in nature. Heredity might play a role in predisposing certain individuals to PD cause. Antibody to Nocardia is found in the serum of PD patients (Kohbata & Shimokawa, 1993). The 125 human brain specimen (including PD, Dementia with Lewy bodies, and other patients) is not positive for filamentous gram-positive nocardiae by Gram staining (Lu et al., 2005), though Nocardia-like beaded cells were present in the midbrain nigral lesions of two patients suffered from encephalitis with a parkinsonian syndrome (Bojinov, 1971 ; Kohbata & Beaman, 1991). On the other hand, an accumulation of acid-fast lipochrome bodies, morphologically identical to filterable forms of Nocardia (i.e., filterable nocardiae), within the neuroglia of midbrain nigral lesion is dense in the early stage of PD (Kohbata et al., 1998).

Filterable Forms of Nocardia: An Infectious Focus in the Parkinsonian Midbrains