Immunocompetent patient with a brain abscess caused by Nocardia beijingensis in Latin America

Solano-Varela, David M; Barrios-Vidales, Edgar M; Plaza, David Fernando; Riveros, William Mauricio; Guzmán, Julián E.; Chica, Claudia E; Patarroyo, Manuel A.

doi:10.1097/md.0000000000014879

Cited by 17 publications

(20 citation statements)

References 18 publications

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“…Of these, 3 occurred in immunocompetent hosts, and all 3 were in Florida. [6][7][8][9][10] The most recent report by Chauhan, in 2019, was the only case in the United States that involved the CNS. 9 Ours is the second reported case of CNS nocardiosis in the United States, and the first with multiple simultaneous manifestations of disseminated nocardiosis.…”

Section: Discussionmentioning

confidence: 99%

A case of Disseminated Nocardia beijingensis in an Immunocompetent Patient, Manifesting as Subcutaneous and CNS Nocardiosis.

Cathcart¹,

Stogsdill²,

Bell³

2020

Journal of Maine Medical Center

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Nocardiosis is an uncommon infection, typically encountered in immunocompromised patients. Only 5 cases have been reported in the United States. We present a case of disseminated Nocardia beijingensis involving the lung, subcutaneous tissue, and central nervous system of an immunocompetent patient.Clinical Findings: A 60-year-old immunocompetent male with no significant medical history presented to our hospital after a complicated medical course, beginning with vague respiratory complaints. His initial work-up revealed a large mass of unclear etiology in the right upper lung. A month later, he had a syncopal episode and then developed focal neurologic deficits.Sputum cultures obtained after the patient's syncopal episode grew gram-positive rods. Results of a computed tomography of the chest showed a new 17-mm subcutaneous mass. The mass was biopsied, which revealed gram-positive rods with partial acid-fast staining. Week later, results of magnetic resonance imaging of his brain showed multiple enhancing lesions with vasogenic edema scattered throughout. A tissue culture from his chest mass was sent to the Mayo Clinic and ultimately grew Nocardia beijingensis. The patient was started on the appropriate antibiotic therapy and has made significant clinical improvement. Conclusions:Though Nocardia is often associated with an immunocompromised state, it can also occur in patients with pulmonary findings and evidence of disseminated disease, particularly central nervous system manifestations, regardless of immune status. A high index of suspicion is needed, as definitive diagnosis often takes weeks due to the slow-growing nature of Nocardia species.

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Section: Discussionmentioning

confidence: 99%

A case of Disseminated Nocardia beijingensis in an Immunocompetent Patient, Manifesting as Subcutaneous and CNS Nocardiosis.

Cathcart¹,

Stogsdill²,

Bell³

2020

Journal of Maine Medical Center

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“…La lesión en la piel era un absceso, lo cual coincide con lo descrito en la literatura médica como resultado de la inoculación directa, que puede causar abscesos y celulitis localizada semejantes a los de la infección por Staphylococcus aureus o estreptococos. Se conoce un caso de nocardiosis con varios abscesos cerebrales en un paciente inmunocompetente internado en el Hospital Universitario Mayor -Méderi, en quien se aisló mediante técnicas moleculares Nocardia beijingensis y que finalmente falleció después de presentar compromiso multisistémico (10).…”

Section: Discussionunclassified

Abscesos cerebrales por Nocardia spp. en una paciente inmunocompetente

Trujillo

Ortiz²,

Perez

et al. 2020

biomedica

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La infección por Nocardia spp. no es común en pacientes inmunocompetentes. El tratamiento antimicrobiano empírico dirigido según las regiones anatómicas, no contempla las particularidades del germen y el análisis microbiológico se hace necesario para el tratamiento específico.A continuación, se presenta el caso de una paciente previamente sana, inmunocompetente y sin factores de riesgo conocidos para la infección por Nocardia spp., con evidencia de compromiso en el parénquima pulmonar y la piel, que posteriormente desarrolló varios abscesos cerebrales.

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“…is known for its tropism to brain tissue and produces neurological symptoms such as: headache, nausea, aphasia, and hemiparesis [22]. Brain abscesses produced by nocardia on MRI studies are seen as areas of purulent necrosis, ring lesions consistent with abscess formation followed by necrosis and edema caused by vascular exudation and infiltration [20,22]. In the present study, MRI studies performed in the patient revealed similar lesions: rounded lesions at the level of the nuclei of the bilateral base, as well as, subcortical cortical lesions in the frontal lobes, parietal and temporal bilateral and at the level of the bilateral cerebellum and of different sizes on T2-weighted imaging (T2-WI) and FLAIR-WI.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Surgical treatment is necessary when collections exist [27]. Stereotaxic biopsy is crucial to make the diagnosis and obtain highly unpredictable antibiotic susceptibility [20,28], but craniotomy must be performed in patients with systemic infections and multiple brain injuries [5]. Aspiration and surgical excision may be indicated for abscesses>2.5 cm.…”

Section: Literature Reviewmentioning

confidence: 99%

Brain Abscess Due To Asian Nocardia in a 63 Years-Old Patient with Adult Still´S Disease: A Rare Case Report and Literature Review

2021

J Psychol Neurosci

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Cerebral nocardiosis is a rare and opportunistic pathology caused by a gram-positive, aerobic bacterium of the order of Actinomycetes called Nocardia spp. It appears in patients with immunodeficiencies affecting cellular immunity. Nocardia can affect an organ (lungs in 75% of cases) or manifest itself as a disseminated infection (central nervous system in 25% of cases). Here we present a rare case of 63-years-old patient immunocompromised by monoclonal biologic treatment for Adult-Onset Still disease (AOSD), who subsequently presents fever, signs of motor focality and resonance imaging findings which show supra and infratentorial lesions. The patient is managed in intensive therapy for sensory impairment, receiving standardized antibiotic scheme, getting through to complicated evolution. Cerebral nocardiosis is a rare infectious disease that requires an early diagnostic study and its respective treatment.

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Immunocompetent patient with a brain abscess caused by Nocardia beijingensis in Latin America

Abstract: Supplemental Digital Content is available in the text

Cited by 17 publications

References 18 publications

A case of Disseminated Nocardia beijingensis in an Immunocompetent Patient, Manifesting as Subcutaneous and CNS Nocardiosis.

A case of Disseminated Nocardia beijingensis in an Immunocompetent Patient, Manifesting as Subcutaneous and CNS Nocardiosis.

Abscesos cerebrales por Nocardia spp. en una paciente inmunocompetente

Brain Abscess Due To Asian Nocardia in a 63 Years-Old Patient with Adult Still´S Disease: A Rare Case Report and Literature Review

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