Nocardial brain abscess

Lin, Yujun; Yang, Ka-Yen; Ho, Ji-Chen; Lee, Tao-Chen; Wang, Hung-Cheng; Su, Feng-Wen

doi:10.1016/j.jocn.2009.01.032

Cited by 48 publications

(49 citation statements)

References 16 publications

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“…Although Nocardia is a rare cause of intracranial abscess, its mortality rate (31 %) is considerably greater than others (<10 %) [4]. Prompt diagnosis followed by aggressive surgical management appear most likely to cure patients with cerebral nocardiosis.…”

Section: Discussionmentioning

confidence: 98%

Nocardial brain abscess in an immunocompetent patient and review of literature

et al. 2016

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Background: Nocardial brain abscesses are associated with significant morbidity and mortality rates. The optimal management remains unclear. Case presentation: We report a case of 49-year-old woman presented with dizziness, progressive headache for 3 days, accompanied with left arm twitched for twice. The patient underwent a right parietal craniotomy for resection of the lesion. Gross total resection of the lesion was achieved. There were no new neurological deficits post-operatively, and no lesions was demonstrated on Gd-enhanced MRI images at six months follow-up. Conclusions: After review of the literature and experience learned from our case, we suggest that craniotomy and surgical resection of the lesions, instead of aspiration, is a safe, efficacious treatment for the patient with nocardial brain abscesses. Long-term chemotherapy and follow-up is mandatory in all cases.

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Section: Discussionmentioning

confidence: 98%

Nocardial brain abscess in an immunocompetent patient and review of literature

et al. 2016

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“…bears tropism for neural tissue and can manifest as cerebral nocardiosis which accounts for 2% of all cerebral abscesses [ The hallmark of CNS nocardiosis a parenchymal abscess that can occur in any region of the brain and can present with nonspecific symptoms like fever, seizures and focal neurological deficit. Risk factors like mitotic pathology and immune-suppression are known predisposing factors [3,7,2]. In competent host, cerebral nocardiosis can present as a mass lesion and are erroneously diagnosed as primary tumor or metastatic lesion diagnosis can also be confused with cerebral abscess due to other microbial causes like bacterial, tubercular, mycotic or parasitic, all of which can present as a ring enhancing lesion on imaging [9].…”

Section: Discussionmentioning

confidence: 99%

“…Craniotomy and excision carries better prognosis in terms of reduced mortality (24%) as compared to non-operative antimicrobial therapy (30%) and aspiration alone (50%) [8]. Combination therapy with total excision of the abscess followed by administration of appropriate antimicrobial therapy is known to result in complete resolution [2].…”

Section: Discussionmentioning

confidence: 99%

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An Unusual Case of Cerebral Nocardiosis Masquerading as Tuberculosis

Gupta

Sarma

Sengupta

et al. 2016

BJMMR

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This is a report of a unique case of cerebral nocardiosis in an immunocompetent host who was initially diagnosed with extra pulmonary tuberculosis not responding to 1 st line anti tubercular treatment (ATT). The deteriorating abscess required multiple drainage procedures before the correct diagnosis was clinched by microbiological analysis. Cerebral nocardiosis is a rare entity, typically occurs in immunocompromised host and is associated with poor prognosis. As it can be easily confused with tuberculosis, a high index of clinical suspicion and supporting microbiological evidence is essential for the correct diagnosis. Priyanka et al.; BJMMR, 18(5): 1-4, 2016 Keywords: Cerebral nocardiosis; tuberculosis; modified ziehl neelsen (ZN) stain. Case Report

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“…Nocardia is a rare cause of intracranial abscesses, representing only 1% to 2% of all such lesions (22), and is rarer still in immunocompetent patients (23). However, the number of the case reports (25)(26)(27)(28).…”

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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Nocardial brain abscess

Cited by 48 publications

References 16 publications

Nocardial brain abscess in an immunocompetent patient and review of literature

Nocardial brain abscess in an immunocompetent patient and review of literature

An Unusual Case of Cerebral Nocardiosis Masquerading as Tuberculosis

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

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