Cerebral nocardiosis

Abstract

Cerebral Nocardiosis is a rare, challenging, opportunistic infectious disease of the central nervous system occurring in both immunocompetent and immunocompromised hosts. It often results in intraparenchymal abscess formation, which represents only 2% of all cerebral abscesses. The diagnosis of cerebral Nocardiosis is seldom based on imaging. Bacteriological diagnosis is often reached only after surgical excision of the abscess. We report a rare case of brain abscess caused by Nocardia species in a 20-year-old immunocompromised lady. Total surgical excision of the abscess, prompt bacteriological diagnosis based on smear and culture of the pus and initiation of specific antimicrobial therapy (trimethoprim and sulfamethoxazole) resulted in good clinical outcome.

Nocardia Brain Abscess in a Patient With Sarcoidosis

“…Nocardia is an aerobic, branching gram-positive rod that can affect both immunocompromised and immunocompetent hosts. Primary infections occur mainly in the lungs or the skin through inhalation or direct inoculation, respectively [2]. The Centers for Disease Control and Prevention (CDC) reported an estimated 500-1,000 cases of nocardiosis infection occurring yearly in the United States, with around 60% of these cases associated with immunocompromised patients [9].…”

“…Localized infections primarily occur in the lung or the skin. Hematogenous spread can also occur causing systemic infections such as central nervous system (CNS) nocardiosis [2]. Cerebral nocardiosis is rare and usually manifests as brain abscesses, although cerebral infiltration, meningitis, ventriculitis, and spinal cord infections have been reported [3].…”

“…Cerebral nocardiosis is rare and usually manifests as brain abscesses, although cerebral infiltration, meningitis, ventriculitis, and spinal cord infections have been reported [3]. Nocardial brain abscess accounts for 2% of all cerebral abscesses carrying the highest mortality rate among bacterial abscesses [2,4,5].…”

“…Some others lacked neurological deficits and presented with systemic manifestations such as low-grade fever and weight loss [1,5]. Misdiagnosis is common due to multiple factors such as difficulty in diagnosis, paucity of disease, and variability of clinical presentations [2,5,6]. Imaging is the first step in diagnosis and findings can consist of one or multiple ring-enhancing lesions on computed tomography (CT) or magnetic resonance imaging (MRI) [1,3,7].…”

“…Optimal treatment for CNS nocardiosis has not been established [1]. Literature reported a combination of regimens that have been used, including antimicrobial therapy, aspiration, craniotomy, or a combination of both medical and surgical management depending on the size and location of the brain abscess and response to treatment [2,5].…”