<i>Nocardia farcinica</i>Brain Abscess: Epidemiology, Pathophysiology, and Literature Review

Kumar, Vivek; Augustine, Deepthi; Panikar, Dilip; Nandakumar, Aswathy; Dinesh, K.K.J. Ranga; Karim, Shamsul; Philip, Rosamma

doi:10.1089/sur.2012.205

Cited by 54 publications

(47 citation statements)

References 35 publications

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“…However, in one-third of the cases, cerebral abscess occurs as an isolated lesion without evidence of extracranial disease [6]. Clinical manifestations of CNS involvement come from local effects of the abscess, usually appearing as multiple enhancing lesions on CT and occasionally accompanied by meningitis [7]. Our patient presented with cerebral abscess accompanied by meningitis, without extracranial disease.…”

Section: Discussionmentioning

confidence: 94%

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Primary Nocardia farcinica Brain Abscess With Secondary Relapsing Meningitis in an Immunocompromised Patient

et al. 2015

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Nocardiosis is an opportunistic infection primarily affecting immunocompromised patients. Central nervous system (CNS) involvement in the form of cerebral abscesses may be a complication of nocardia infection. Nocardia farcinica, in particular, is believed to disseminate the CNS more often than other nocardia species, being associated with antibiotic resistance and therefore higher mortality. We describe the first case of a patient with relapsing meningitis caused by N. farcinica. A 61-year-old Caucasian man was admitted for evaluation of fever, headache and confusion. Magnetic resonance imaging of the brain revealed cerebral abscesses and examination of the cerebrospinal fluid (CSF), polymorphonuclear count, elevated protein and hypoglycorrhachia. CSF cultures were negative, while multiplex polymerase chain reaction showed Staphylococcus aureus. The patient received vancomycin/meropenem and later, because he was still febrile, with symptoms from the CNS, linezolid/meropenem, in which he responded well. During the following months, he had to discontinue linezolid because of myelosuppression with subsequent relapses of meningitis. In such a relapse, the patient was admitted for reevaluation. CNS cultures grew N. farcinica, susceptible to linezolid, trimethoprim/sulfamethoxazol and ceftriaxone. He was discharged on trimethoprim/sulfamethoxazole for 12 months. This is the first reported case of relapsing meningitis caused by N. farcinica. It highlights, on the one hand, the importance of the prolonged treatment in relapse's prevention and on the other, the limited value of linezolid as prolonged treatment due to its long-term toxicities.

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Section: Discussionmentioning

confidence: 94%

“…Nocardia spp. are difficult to culture, grow slowly and their growth may be contaminated by faster growing species, delaying the start of the appropriate antibiotic treatment [4,7]. Prolonged course of oral antimicrobials (> 12 months) is considered necessary to prevent relapses [8].…”

Section: Discussionmentioning

confidence: 99%

Primary Nocardia farcinica Brain Abscess With Secondary Relapsing Meningitis in an Immunocompromised Patient

et al. 2015

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“…While the most common cause of CNS disease is N. asteroides, which accounts for 35% of cases (60), N. farcinica is particularly neurotropic (61). This has important therapeutic implications as N. farcinica is resistant to a number of antibiotics commonly used to treat nocardiosis, including trimethoprim-sulfamethoxazole in up to 80% of cases (62).…”

Section: Nocardiamentioning

confidence: 99%

Central Nervous System Infections

2016

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“…Las infecciones cerebrales por Nocardia farcínica tienen una mortalidad global superior a 20% en pacientes inmunocomprometidos 2 . Existe poca experiencia en pacientes inmunocompetentes, por lo cual se reportan 2 casos de absceso cerebral causados por este agente.…”

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Absceso Cerebral por Nocardia spp. en paciente inmunocompetente. Presentación de 2 casos

Rodríguez

2018

Bol. Micol.

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ResumeNNocardia corresponde a un género de bacterias gram positivo que puede producir compromiso pulmonar, sistémico y abscesos cerebrales, especialmente en pacientes inmunocomprometidos. La infección cerebral por Nocardia spp es extremadamente infrecuente en pacientes inmunocompetentes, por lo cual se reportan dos casos: caso 1: mujer de 61 años, sana, consulta por cefalea y paresia en hemicuerpo izquierdo. Estudio con TAC y RM de encéfalo demuestran absceso cerebral. Se inició tratamiento con ceftriaxona mas cloxacilina y fue drenado quirúrgicamente. En el cultivo del LCR se aisló Nocardia spp. cambián-dose esquema a cotrimoxazol con meropenem por 6 semanas. Caso 2: varón de 72 años, hipertenso y tabáquico crónico. Consultó por cefalea, paresia de extremidad inferior derecha y pérdida de visión de ojo derecho. Estudio con TAC y RM de encéfa-lo objetiva absceso cerebral parietal izquierdo. Se inició tratamiento con ceftriaxona, metronidazol y vancomicina. Se realizó drenaje quirúrgico. El cultivo de absceso resultó positivo para Nocardia spp, ajustándose esquema a cotrimoxazol y meropenem por 6 semanas. Requirió tratamiento prolongado por presentar lenta regresión clínica e imagenoló-gica. ABstRACtNocardia is a gram positive bacterial genus. Is involved in pulmonary, systemic and brain abscess usually in immunocompromised patients. Nocardia spp. brain infection is extremely rare in immunocompetent patients, hereby we report 2 cases: case 1: 61 years old woman, without morbid conditions, consulted for headache and left he- Bol.Micol. 2018; 33(1):26-31 mICROBIOLOGIA micologia.uv.cl

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Nocardia farcinicaBrain Abscess: Epidemiology, Pathophysiology, and Literature Review

Cited by 54 publications

References 35 publications

Primary Nocardia farcinica Brain Abscess With Secondary Relapsing Meningitis in an Immunocompromised Patient

Primary Nocardia farcinica Brain Abscess With Secondary Relapsing Meningitis in an Immunocompromised Patient

Central Nervous System Infections

Absceso Cerebral por Nocardia spp. en paciente inmunocompetente. Presentación de 2 casos

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