Absceso recidivante por Nocardia asteroides en una paciente portadora de poliglobulia primaria

Aboal, Carlos; Salamano, Ronald; Braselli, A; Mansilla, Mariel; Galaret, Maria; Pedreira, Walter

doi:10.1590/s0004-282x2006000300034

Cited by 4 publications

(3 citation statements)

References 6 publications

(14 reference statements)

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“…Nocardiosis is an uncommon disease, but its frequency has increased due to the high number of immunosuppressive treatments, improved diagnostic facilities, and increasing survival times of patients with malignancy 18. Patients become infected by inhalation, direct traumatic cutaneous inoculation, or by eating contaminated food 19. The most common primary site of nocardiosis is the respiratory tract, being the origin of hematogenic dissemination with a high incidence to the skin, subcutaneous tissue, or CNS 6,19,20.…”

Section: Discussionmentioning

confidence: 99%

“…Patients become infected by inhalation, direct traumatic cutaneous inoculation, or by eating contaminated food 19. The most common primary site of nocardiosis is the respiratory tract, being the origin of hematogenic dissemination with a high incidence to the skin, subcutaneous tissue, or CNS 6,19,20. Extra-pulmonary manifestations of nocardiosis include CNS abscesses or meningitis,6 chorioiditis,6 intraocular vasculitis,21 or renal abscesses 22.…”

Section: Discussionmentioning

confidence: 99%

“…There is growing evidence that the size of the cerebral lesion and clinical and immune status of the patient are relevant to surgical decision making. In spite of the existing controversy with regard to the surgical management of these lesions, an early diagnosis through stereotactic aspiration and the beginning of an antibiotic therapy are essential for a favorable outcome 19. In most cases of cerebral nocardiosis the overall prognosis is favorable upon adequate antibiotic or surgical therapy 30.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Cerebellar Nocardiosis and Myopathy from Long-Term Corticosteroids for Idiopathic Thrombocytopenia

Frank¹,

Woschnagg²,

Mölzer³

et al. 2010

Yonsei Med J

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Infection of the central nervous system with Nocardia sp. usually manifests as supratentorial abscesses. Supratentorial and cerebellar abscesses from infection with Nocardia sp. following immunosuppression with long-term corticosteroids for idiopathic thrombocytopenia (ITP) have not been reported. An 83 years-old, human immunodeficiency virus (HIV)-negative, polymorbid male with ITP for which he required corticosteroids since age 53 years developed tiredness, dyspnoea, hemoptysis, abdominal pain, and progressive gait disturbance. Imaging studies of the lung revealed an enhancing tumour in the right upper lobe with central and peripheral necrosis, multiple irregularly contoured hyperdensities over both lungs, and right-sided pleural effusions. Sputum culture grew Nocardia sp. Neurological diagnostic work-up revealed dysarthria, dysphagia, ptosis, hypoacusis, tremor, dysdiadochokinesia, proximal weakness of the lower limbs, diffuse wasting, and stocking-type sensory disturbances. The neurological deficits were attributed to an abscess in the upper cerebellar vermis, myopathy from corticosteroids, and polyneuropathy. Meropenem for 37 days and trimethoprime-sulfamethoxazole for 3 months resulted in a reduction of the pulmonary, but not the cerebral lesions. Therefore, sultamicillin was begun, but without success. Long-term therapy with corticosteroids for ITP may induce not only steroid myopathy but also immune-incompetence with the development of pulmonary and cerebral nocardiosis. Cerebral nocardiosis may not sufficiently respond to long-term antibiotic therapy why switching to alternative antibiotics or surgery may be necessary.

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