Clinical Presentation, Management, and Outcomes of Patients With Brain Abscess due to Nocardia Species

Abstract

Background Nocardial brain abscesses are rare, and published literature describing brain abscesses due to Nocardia species is limited to individual case reports or small series. We report one of the largest contemporary retrospective studies describing risk factors, diagnostic evaluation, management, and outcomes of nocardial brain abscess. Methods Retrospective review of all adults with brain abscess due to culture-confirmed Nocardia species at our institution between January 1, 2009, and June 30, 2020. Results Overall, 24 patients had nocardial brain abscesses during the study period. The median age at presentation was 64 years, and 62.5% were immunocompromised. Pulmonary and cutaneous infections were the most common primary sites of nocardial infection. All 24 patients had magnetic resonance imaging performed, and the frontal lobe was the most commonly involved. The most common organism isolated was Nocardia farcinica, followed by Nocardia wallacei and Nocardia cyriacigeorgica. Thirteen patients were managed with antimicrobial therapy alone, while 11 had both medical and surgical management. In all patients, dual therapy was recommended for the initial 6 weeks of treatment, and 22 patients received at least 1 oral agent as part of their final antibiotic regimen, predominantly trimethoprim-sulfamethoxazole and linezolid. Fourteen patients achieved complete clinical and radiographic resolution of infection. Conclusions Nocardia is an important cause of brain abscess in the immunocompromised host. Early diagnostic and therapeutic aspiration may help health care providers confirm the diagnosis, choose an appropriate antimicrobial regimen, and achieve source control.

Culture on Selective Media and Amplicon-Based Sequencing of 16S rRNA from Spontaneous Brain Abscess—the View from the Diagnostic Laboratory

“…Our case series is unusual with three cases of Listeria monocytogenes , a well-known cause of meningitis and meningoencephalitis that is rarely involved in brain abscess ( 16 ). Nocardia species are recognized pathogens of brain abscess ( 1 , 12 , 17 , 18 ), while the low prevalence of S. aureus in the present study probably springs from exclusion of cases with recent brain surgery. Otherwise, our results from conventional culture are typical, with the S. anginosus group being the major pathogen, frequent identification of A. aphrophilus and the F. nucleatum group, and significant detection of Prevotella , Campylobacter , and Actinomyces .…”

Educational Case: Brain abscess

“… 18 Nocardia species are an important cause of brain abscess in immunocompromised patients. 19 Fungi such as Aspergillus species can also cause brain lesions with necrosis in immunocompromised patients. 20 …”

Brain Abscess Caused by Nocardia farcinica and Diagnosed by Metagenomic Next-Generation Sequencing: A Case Report

“…Case reports and small sample cohorts described the clinical features, treatment, and prognosis of nocardial brain abscess ( 5 , 14 ). Nocardial brain abscess occurs in people aged 50–60 years ( 15 ).…”

“…Routine diagnostic methods are blood, cerebrospinal fluid, and brain aspirate culture, and craniotomy is generally performed to remove a lesion and obtain a specimen. According to the literature, 45.8% of patients underwent both medical and surgical management ( 5 ). Currently, metagenomic next-generation sequencing (mNGS) is being performed to identify pathogens in many infectious diseases, with high sensitivity and specificity ( 6 ).…”