Frequent "contaminants" detected during mycobacterial culture of decontaminated samples are bacteria of the order Actinomycetales. These are usually bacteria classified as the family Corynebacterineae, genera Corynebacterium, Dietzia, Gordonia, Nocardia, Rhodococcus and Tsukamurella. These bacteria frequently colonize the airways and, under certain circumstances, they may cause life-threatening diseases. In severely immunocompromised patients, they regularly cause life-threatening infections with bacteria of the genus Nocardia. These filamentous bacteria, developing aerial mycelium in the culture, are partly acid-resistant and resistant to lysozyme. They cause nocardiosis, a rare but serious disease in patients with various types of immune deficiency. Differential diagnosis must distinguish between the genera Streptomyces, Actinomadura and Nocardiopsis and other soil saprophytes that are not acid-resistant, sensitive to lysozyme and faster growing. They frequently colonize the airways of patients with lung disease but very rarely cause diseases. The diagnosis of aerobic actinomycetes and determination of their sensitivity to antibiotics are problematic since they grow longer, are difficult to stain and are involved in atypical biochemical reactions. Precise identification of the genera and species requires polyphasic identification of isolates using molecular microbiology methods. If diagnosed early, infections caused by aerobic actinomycetes are easy to treat with targeted antibiotic therapy.