Nocardia brain abscess: severe CNS infection that needs aggressive management; case report

Abstract

Nocardia brain abscess is a rare central nervous system (CNS) infection that carries a high mortality rate reaching 34% which is considered the highest amongst brain abscesses caused by microorganisms. All available literature is in the form of retrospective studies and small case series. In this case report the authors present a patient whose course of disease was stormy and required multiple neurosurgical procedures. The clinical outcome, long-term follow up and a review of the literature is discussed.

Nocardial abscesses occurring in both sides of brain in an immunodeficient individual

“…[1] Nocardial brain abscess is one of the common presentations in nocardiosis, but bilateral nocardial brain abscesses are rare. [3] Here we report a patient with bilateral nocardial brain abscesses, who was successfully treated with conservative therapy. [2] Total excision or aspiration is necessary in most cases.…”

Multiple nocardial abscesses of the brainstem and spinal cord diagnosed after an open biopsy through a cervical partial central corpectomy: case report

“…22 Solitary involvement of the spinal cord, on the other hand, is very rare, and only very few cases have been reported. 1,[6][7][8]12,13,21 Spinal abscesses are more frequently found in the lower spinal levels.…”

“…11 Lee et al and Zakaria et al recommend a less-aggressive approach with repeated aspirations if necessary in addition to antibiotic treatment. 10,22 Concerning spinal cord abscesses, there are no clear recommendations. Based on the reported cases, it appears that laminectomy is usually performed, if feasible, to aspirate or enucleate the abscess.…”

“…Nocardia is a gram-positive, partially acid-fast, catalase-and urease-positive bacterium that grows aerobically. 22 Under direct microscopy, Nocardia appears as a filamentous bacterium with hyphae-like branching. 20 Infection with Nocardia (nocardiosis) is usually acquired by inhalation, and therefore the most common clinical presentation is pulmonary nocardiosis.…”

“…20 Nocardia was first identified by Edmond Nocard in 1888. 22 These organisms may be found in soil, decomposing vegetation, and other organic matter; they can also be found in fresh and salt water. 20 Nocardia asteroides complex is the subgroup that causes the most clinical human nocardial infections.…”