Nocardia abscessus brain abscess in an immunocompetent host

Tawfiq, Jaffar A. Al; Mayman, Talal; Memish, Ziad A.

doi:10.1016/j.jiph.2012.11.012

Cited by 20 publications

(20 citation statements)

References 19 publications

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“…[39][40][41][42][43][44] To our knowledge, N. abscessus brain abscess in an immunocompetent host has been reported five times in the literature. [10,13,[45][46][47] In this report we present a sixth case of cerebral abscess by N. abscessus in an immunocompetent patient.…”

Section: Discussionmentioning

confidence: 91%

“…[1,2,4,15,34,48] Four out of the five reported cases detailed the methods of microbiological detection of the organism and treatment specifications. [45][46][47] All were partially acid-fast positive. Routine cultures were negative and the diagnosis of the N. abscessus was done by molecular methods except in one case where the culture yielded Nocardia.…”

Section: Discussionmentioning

confidence: 99%

“…[46,48] There is no reported mor-tality in the five reported cases of brain abscess caused by N. abscessus pathogen in the immunocompetent patients. [10,13,[45][46][47] Two of the cases were treated solely by antibiotic. [13,45] The other three cases were treated by combinations of antibiotics and surgical evacuation.…”

Section: Discussionmentioning

confidence: 99%

“…[13,45] The other three cases were treated by combinations of antibiotics and surgical evacuation. [10,46,47] As all Nocardia species, laboratory identification might be challenging using routine culture methods. [1,2,4,15,34,48] Four out of the five reported cases detailed the methods of microbiological detection of the organism and treatment specifications.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Immunocompetent patient with Nocardia abscessus brain abscess: Case report and review of the literature

Alsalmi

Bugdadi

Alkhayri³

et al. 2018

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Nocardia cerebral abscess is uncommon. It accounts for 1%-2% of all cerebral abscesses. It typically occurs in immunocompromised patients but cases in immunocompetent hosts been reported. Diagnosis of Nocardia brain abscess can be difficult and misleading. In this report we report a case of Nocardia abscessus brain abscess that was misdiagnosed initially as brain tumor. The patient has been successfully managed medically along with surgical evacuation twice.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Immunocompetent patient with Nocardia abscessus brain abscess: Case report and review of the literature

Alsalmi

Bugdadi

Alkhayri³

et al. 2018

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“…Nocardia brain abscess are rare and accounts for only 1-2% of all cerebral abscesses 9 . The mortality rate is 31% which is much greater than that of other agents that can cause cerebral abscesses being less than 10% 10 .…”

Section: Discussionmentioning

confidence: 99%

A complicated case of an immunocompetent patient with disseminated nocardiosis

Cooper

Said

Popp

et al. 2014

Infectious Disease Reports

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Nocardia species are aerobic, gram positive filamentous branching bacteria that have the potential to cause localized or disseminated infection. Nocardiosis is a rare disease that usually affects immunocompromised patients and presents as either pulmonary, cutaneous or disseminated nocardiosis. Forty-two year-old hispanic male presented to our care with bilateral lower extremity weakness, frontal headache, subjective fever, nausea, and vomiting. Brain computed tomography (CT) revealed multiple hyperdense lesions with vasogenic edema in the frontal, parietal and left temporal lobes. Chest CT demonstrated bilateral cavitary nodules in the lung and right hilar lymphadenopathy. Brain magnetic resonance imaging revealed multiple bilateral supratentorial and infratentorial rim enhancing lesions involving the subcortical gray-white matter interface with vasogenic edema. Patient was started on empiric therapy for unknown infectious etiology with no response. He eventually expired and autopsy findings revealed a right hilar lung abscess and multiple brain abscesses. Microscopic and culture findings from tissue sample during autopsy revealed nocardia wallacei species with multidrug resistance. The cause of death was stated as systemic nocadiosis (nocardia pneumonitis and encephalitis). The presence of simultaneous lung and brain abscesses is a reliable indication of an underlying Nocardia infection. An increased awareness of the various presentations of nocardiosis and a high index of clinical suspicion can help in a rapid diagnosis and improve survival in an otherwise fatal disease. This case highlights the importance of obtaining a tissue biopsy for definitive diagnosis on the initial presentation when an infectious process is considered in the differential diagnosis and early treatment can be initiated.

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Bleb-Associated Exogenous Nocardia Endophthalmitis

2017

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A woman in her 60s with known human leukocyte antigen B27 positivity was referred for protracted intraocular inflammation and intractable pain 5 months after trabeculectomy in the right eye. On presentation, best-corrected visual acuity was 20/100. Ultrasonographic imaging showed moderate vitritis, and slitlamp examination mirrored this (Figure , A).Anterior chamber aspirates, which required a vitrector to extract, demonstrated filamentous, acid-fast, gram-positive nocardia (Figure , B). Despite aggressive treatment with intravitreal amikacin/vancomycin and oral cotrimoxazole, guided by culture and sensitivity analyses, the eye was ultimately enucleated.Despite favorable in vitro susceptibility profiles, advanced intraocular nocardia infections remain challenging to eradicate owing to abscess formation in the eye 1,2 and elsewhere, 3 and they are associated with poor ocular outcomes. 4 Early postcataract nocardia endophthalmitis has been successfully treated with combined topical and oral cotrimoxazole 5,6 but is often difficult to diagnose, mimicking chronic inflammation or fungal infection. Earlier recognition of the characteristic cotton-ball infiltrates may accelerate diagnosis/treatment and improve outcomes.

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Nocardia abscessus brain abscess in an immunocompetent host

Cited by 20 publications

References 19 publications

Immunocompetent patient with Nocardia abscessus brain abscess: Case report and review of the literature

Immunocompetent patient with Nocardia abscessus brain abscess: Case report and review of the literature

A complicated case of an immunocompetent patient with disseminated nocardiosis

Bleb-Associated Exogenous Nocardia Endophthalmitis

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