Central nervous system nocardiosis in Queensland

Abstract

Nocardia infection of the central nervous system (CNS) is an uncommon but clinically important disease, often occurring in immunocompromised individuals and carrying a high mortality rate. We present 20 cases of microbiologically proven CNS nocardiosis diagnosed in Queensland from 1997 to 2015 and review the literature from 1997 to 2016.Over 50% of cases occurred in immunocompromised individuals, with corticosteroid use posing a particularly significant risk factor. Nine (45%) patients were immunocompetent and 3 had no comorbidities at time of diagnosis. Nocardia farcinica was the most frequently isolated species (8/20) and resistance to trimethoprim–sulfamethoxazole (TMP-SMX) was found in 2 isolates. Overall, 35% of our patients died within 1 year, with the majority of deaths occurring in the first month following diagnosis. Interestingly, of the 7 deaths occurring at 1 year, 6 were attributed to N farcinica with the seventh isolate being unspeciated, suggesting the virulence of the N farcinica strain.

Nocardia paucivorans brain abscess. Clinical and microbiological characteristics

“…Four patients recovered from neurological clinical symptoms but with sequelae. Despite the high mortality rate reported in patients with cerebral nocardiosis, ranging from 31% to 55% [ 1 , 12 ], no patient died in our review.…”

“…Only 33 patient strains were characterized as N. paucivorans among approximately 1800 isolates of Nocardia species [ 7 ]. Using the MEDLINE database back to the year 2000, we found sixteen cases of brain abscess caused by N. paucivorans in the world medical literature [ [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] ]. The clinical features of the sixteen patients and the one described herein are summarized in Table 1 .…”

“… 15 [ 12 ] 80/F None Brain, lung Right hemiparesis, memory impairment Multiple ring-enhancing brain lesions NR Surgery. Cef + TMP-SMX (35 d); TMP-SMX (9 mo) Cured at 1 yr of follow-up 16 [ 12 ] 59/M None Brain, lung Headache, confusion Multiple ring-enhancing brain lesions and hydrocephalus NR EVD. Mer + TMP-SMX (2 mo); TMP-SMX (12 mo) Recovered with neurologic sequelae at 1 yr of follow-up 17 [PR] 63/M Ocular myasthenia gravis.…”

“…Thus, treatment is based on case series and expert opinion. TMP-SMX is the mainstay of treatment of Nocardia , and it is the drug of choice for cerebral nocardiosis due to its good penetration in the CNS [ 1 , 2 , 12 ]. As empiric treatment, Rafiei et al [ 12 ] recommended intravenous TMP-SMX plus meropenem for brain nocardiosis.…”

“…We have recently studied a patient with a brain abscess caused by N. paucivorans . The literature has provided limited guidance regarding the care of patients with this condition [ [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] ]. Thus, a review of this topic seems timely.…”