Four cases of nocardial brain abscess

Tamarit, M.; Poveda, P; Baron, Miriam J.; Jm, del Pozo García

doi:10.4103/2152-7806.99927

Cited by 21 publications

(26 citation statements)

References 7 publications

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“…Isolated brain metastasis without extracerebral metastasis and meningeal involvement is further less common, reports only being in the form of Mainstay of treatment of Nocardia brain abscess remains to be surgical aspiration or excision along with long term antibiotics [14]. Treatment is recommended with two intravenous antibiotics for 3-6 weeks followed by oral antibiotics for around 6-12 months [15,16]. Susceptibility testing should be used to guide antibiotic choice due to high frequency of anti-microbial resistance especially with Nocardia farcinica [17].…”

Section: Discussionmentioning

confidence: 99%

Urothelial Carcinoma with Intracranial Lesion: Metastasis or Abscess?

Jain¹,

Gupta²,

Natasha³

et al. 2018

Clin Med Rev Case Rep

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Section: Discussionmentioning

confidence: 99%

Urothelial Carcinoma with Intracranial Lesion: Metastasis or Abscess?

Jain¹,

Gupta²,

Natasha³

et al. 2018

Clin Med Rev Case Rep

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“…However, the number of the case reports (25)(26)(27)(28). Nearly onehalf of the cases involved primary brain abscesses.…”

Section: Discussionmentioning

confidence: 99%

Creation of an In-House Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry Corynebacterineae Database Overcomes Difficulties in Identification of Nocardia farcinica Clinical Isolates

et al. 2015

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e Nocardiosis is a rare disease that is caused by Gram-positive actinobacteria of the Nocardia genus and affects predominantly immunocompromised patients. In its disseminated form, it has a predilection for the central nervous system and is associated with high mortality rates. Therefore, prompt identification of the pathogen is critical. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry is a relatively novel technique used for identification of microorganisms. In this work, an upgraded MALDI-TOF Biotyper database containing Corynebacterineae representatives of strains deposited in the Polish Collection of Microorganisms was created and used for identification of the strain isolated from a nocardial brain abscess, mimicking a brain tumor, in an immunocompetent patient. Testing with the API Coryne system initially incorrectly identified Rhodococcus sp., while chemotaxonomic tests, especially mycolic acid analysis, enabled correct Nocardia identification only at the genus level. Subsequent sequence analysis of 16S rRNA and secA1 genes confirmed the identification. To improve the accuracy of the results, an in-house database was constructed using optimized parameters; with the use of the database, the strain was eventually identified as Nocardia farcinica. Clinical laboratories processing various clinical strains can upgrade a commercial database to improve and to accelerate the results obtained. This is especially important in the case of Nocardia, for which valid microbial diagnosis remains challenging; reference laboratories are often required to identify and to survey these rare actinobacteria.N ocardia represents Gram-positive actinobacteria that are etiological agents of the rare disease nocardiosis, which affects predominantly immunocompromised patients. Nocardiosis usually presents itself as a solitary lesion located in lung, skin, or brain (primary nocardiosis), but sometimes disseminated nocardiosis with multiple sites is observed. Nocardia spp. show a marked predilection for the central nervous system (CNS) (1).Nocardiosis of the CNS constitutes about 40% of all cases of disseminated nocardioses and is associated with high mortality rates. The true incidence of Nocardia infections is difficult to assess, because of problems with the identification of these bacteria. Many different phenotypic, chemotaxonomic, or genotyping methods are available, but each method possesses drawbacks; for this reason, fast reliable identification of Nocardia isolates is very important. Because Nocardia spp. differ in antibiotic susceptibility, correct identification of clinical strains is critical for adequate treatment.Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (MS) has been introduced for microbial identification in the past few years. Its reliability, accuracy, and cost-effectiveness have been well described in the literature (2-4). This method can be used to identify microorganisms from all domains of life, i.e., Archaea, Bacteria, and E...

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“…In all patients surgical drainage of brain abscess was done and one patient died despite of treatment [9].…”

Section: Case Reportmentioning

confidence: 99%

Brain and Lung Abscesses in a 48-year-old Man with Focal and Segmental Glomerulosclerosis

Momeni

Rahmani

Nasri

2015

JCDR

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Case RepoRtWe report a case of FSGS (tip lesion) with nephrotic syndrome and acute renal failure that complicated with pulmonary and brain abscesses and was under immunosuppressive therapy. The patient was a 48-year-old man who was admitted for evaluation of azotemia. There was a history of decreased urine volume in recent days. He presented with BP=160/100 and 3+ leg edema on physical examination. He did not have any history of recent sore throat, hypertension (HTN), oral ulcer, arthralgia, photophobia, skin rash or family history of renal disease. Urinlysis showed 3 + proteinuria and 2+hematuria. Serum creatinine was 2.3 mg/dl, blood urea nitrogen=32mg/dl, serum albumin=2.4g/dl, triglyceride=295mg/ dl, cholesterol=320mg/dl, Hb=13g/dl and 24 h urine protein was 6580 mg/day. Other laboratory findings were unremarkable. He was oliguric and the serum creatinine gradually increased to 6.8 mg/ dl during the next few days. Microscopic urine sediment showed many muddy brown coarse granular cast, dysmorphic RBC and fatty cast. Because of elevated serum creatinine and uncontrolled hypertension and volume overloading, hemodialysis was started and after blood-pressure control (by amlodipine 10mg/day, prazocine 5mg/bid, metoprolol 50mg/bid), renal biopsy was done. The results of serologic examination including ANA, anti-ds DNA, C3, C4, CH50, HBS Ag, HCV Ab, HIV Ab, Cryoglobulin, Anti GBM Ab and ASO were normal. Renal biopsy showed focal segmental glomerulosclerosis (tip lesion type) as well as acute tubular necrosis. Corticosteroid pulse (methyl prednisolone 1000 mg/day) was prescribed for three days and continued with 60 mg prednisolone/day. Conservative management of metabolic acidosis, hyperlipidemia, anemia and hypocalcemia was continued. after hemodialysis three times daily (HD), urine output increased and serum creatinine decreased gradually to 1.5 mg/dl and his oedema decreased to 1+ after two weeks of admission, so he was discharged and prednisolone was tapered gradually to 20 mg/day during 4 months. Because serum creatinine was increased, cyclosporine 100 mg/bid was started and after four weeks, serum creatinine reached to 0.8 mg/dl and urine protein was 740 mg/day. Six weeks later, he suffered from productive cough and shaking chill and fever. Chest x ray and chest CT scan revealed right side pulmonary abscess [Table/ Fig-1]. BK (Bacille de Koch) smear of sputum was negative. Treatment with ceftriaxone 1g/bid/IV infusion and clindamycin 600mg/tds/IV infusion was prescribed and after four days, fever disappeared. After two weeks of parenteral treatment, he was discharged and oral antibiotics with Amoxicillin-clavulanate 625mg/TDS continued for four additional weeks, and the, second lung CT scan was near normal [Table/ Fig-2]. Cyclosporine dose was reduced to 100 mg/day and serum creatinine remained 1.5 mg/dl. After three months he was again referred to clinic with dysarthria and right side face deviation and hence was admitted. A large round mass like lesion was detected in his right side brain CT scan and MRI [Ta...

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Four cases of nocardial brain abscess

Cited by 21 publications

References 7 publications

Urothelial Carcinoma with Intracranial Lesion: Metastasis or Abscess?

Urothelial Carcinoma with Intracranial Lesion: Metastasis or Abscess?

Creation of an In-House Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry Corynebacterineae Database Overcomes Difficulties in Identification of Nocardia farcinica Clinical Isolates

Brain and Lung Abscesses in a 48-year-old Man with Focal and Segmental Glomerulosclerosis

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