Primary Brain Abscess Caused by <i>Nocardia otitidiscaviarum</i>

Abstract

Diagnosing primary cerebral nocardiosis is difficult. This case report describes a 79-year-old immunocompetent Japanese woman with a primary brain abscess caused by Nocardia otitidiscaviarum (IFM 11321) and reviews the findings of 11 previous patients with N. otitidiscaviarum-induced brain abscesses. Four patients survived, including ours. Beta-lactams were not effective in our patient, and the diagnosis required a pathologic analysis of the surgical specimen. Sulfamethoxazole/trimethoprim (ST) was administered to the patient. On antibiotic susceptibility testing, N. otitidiscaviarum (IFM11321) was found to be resistant to amoxicillin-clavulanic acid, ceftriaxone, cefotaxime, cefepime, imipenem and clarithromycin, but sensitive to amikacin, gentamicin, ST and linezolid. Antimicrobial susceptibility patterns differ among Nocardia species, making species identification important for treatment. Patients with suspected Nocardia infection should therefore be treated empirically with ST and/or amikacin and considered for surgical management.

Severe pneumonia due to Nocardia otitidiscaviarum identified by mass spectroscopy in a cotton farmer

“…In spite of the fact that nocardiosis are being increasingly recognized, infections due to N otitidiscaviarum , comprising about only 0.3% to 2.9% of all Nocardia infections, [12] remain infrequently reported. [13] Beaman et al described that only 10 cases from 347 patients infected by Nocardia in United States were identified as N otitidiscaviarum infection.…”

“…[7] However, it has been reported in both immunocompromised and immunocompetent individuals to be a cause of pulmonary, primary cutaneous, and lymphocutaneous infections. [12] Individuals with weakened immune system, such as patients suffering from diabetes mellitus, chronic obstructive pulmonary disease, mixed connective tissue disorder, ulcerative colitis, cirrhosis, human immunodeficiency virus infection, malignancies, those receiving long-term or large dose of corticosteroid therapy, and bone marrow or solid organ transplant, are at higher risk. [18–20] In this case, the patient has no immunocompromised disorders, but 10 pack-years smoking history, which could be a risk factor to weaken the defense capability in lungs.…”

Microbiological and clinical data analysis of 32 patients with Nocardia infections in Yantai

“…have been identified to date, of which more than 30 are human pathogens (1)(2)(3)(4). Nocardia infections are commonly observed in individuals who undergo bone marrow or solid organ transplantation, patients on longterm steroid therapy, and patients with malignancies (5).…”

Disseminated infection with Nocardia otitidiscaviarum in a patient under steroid therapy

“…Nocardia otitidiscaviarum has been described as an opportunistic pathogen in human . However, it has been reported in both immunocompromised and immunocompetent individuals causing pulmonary, primary cutaneous, and lymphocutaneous infections . Individuals with weak immune system, such as patients suffering from chronic obstructive pulmonary disease, diabetes mellitus, mixed connective tissue disorder, ulcerative colitis, cirrhosis, human immunodeficiency virus infection, malignancies, those receiving long‐term corticosteroid therapy, and bone marrow or solid organ transplant, are at higher risk …”

“…10,11 However, it has been reported in both immunocompromised and immunocompetent individuals causing pulmonary, primary cutaneous, and lymphocutaneous infections. 11,12 Individuals with weak immune system, such as patients suffering from chronic obstructive pulmonary disease, diabetes mellitus, mixed connective tissue disorder, ulcerative colitis, cirrhosis, human immunodeficiency virus infection, malignancies, those receiving long-term corticosteroid therapy, and bone marrow or solid organ transplant, are at higher risk. 11,13 Nocardia infection has nonspecific pathogenic signs or symptoms, and its clinical picture may mimic a variety of other bacterial infections including actinomycosis, tuberculosis, fungal infections, and malignancies.…”