Clinical Characteristics and Treatment Outcome of Central Nervous System Nocardiosis: A Systematic Review of Reported Cases

Abstract

Background: The clinical spectrum of systemic nocardiosis encompasses pulmonary and disseminated disease. Central nervous system (CNS) involvement is an important feature of disseminated disease with significant mortality and high relapse rate, especially in those with suppressed cell-mediated immunity. This systematic review aimed to evaluate the epidemiology, clinical features, diagnosis, therapeutic interventions, and outcome in patients with CNS nocardiosis. Methods: The literature search was performed in major databases (PubMed, Google Scholar, and Scopus) by using distinct keywords: “CNS disease,” “Nocardia,” “meningitis,” “brain abscess,” “disseminated disease,” and “Cotrimoxazole.” All patients ≥18 years with CNS nocardiosis reported between January 2000 to December 2020 were included. Results: A total of 129 articles were included in the final analysis. The mean age of patients was 55±16 years, and the majority were male (70.8%). Nocardia farcinica was the commonest species (39.6%), followed by Nocardia nova (5.9%). Thirty-four percent of the patients were found to be immunocompetent. Corticosteroid use was the most common predisposing factor (55.8%). Among neuroimaging findings, brain abscess was most common (86.9%), followed by leptomeningeal enhancement (12.1%). The overall case-fatality rate in CNS disease was 22.8%. On multivariate analysis, patients underwent surgery (OR 2.4, 95% CI 0.99-4.11, p-value 0.046) had better survival than those treated with antimicrobial therapy alone. Immunodeficient state (OR 0.32, 95% CI 0.15-0.90, p-value 0.019) was independently associated with poor outcome. Conclusion: CNS nocardiosis carries significant mortality, particularly in immunodeficient patients. We advocate the use of surgery in the combination of antimicrobials to improve clinical outcome.

Co-infection with Mycobacterium tuberculosis and Nocardia farcinica in a COPD patient: a case report

“…Furthermore, COPD is frequently associated with PN and the central nervous system (CNS) is the second most common site of infection, usually through dissemination from primary pulmonary focus [ 4 , 5 ]. CNS involvement can be seen in 3–26% of patients with nocardiosis [ 17 ]. However, identification of Nocardia is extremely difficult because nocardiosis is not well understood by clinicians and the culture of Nocardia is difficult.…”

The epidemiology, clinical presentation and treatment outcomes in CNS actinomycosis: a systematic review of reported cases

“…Recent reports have also shown promising results of MALDI-TOF comparable to 16S rRNA sequencing [ 35 ]. Neuroimaging in CNS actinomycosis shows brain abscess in more than 50% of the cases [ 14 ], similar to nocardiosis and neuroaspergillosis [ 30 , 36 ]. The high predilection of the temporal lobe was reported in the previous systematic review [ 14 ].…”

Co-Infektion mit Mycobacterium tuberculosisund Nocardia farcinica bei einer COPD-Patientin: ein Fallbericht

“…Zudem wird die COPD oftmals mit PN in Verbindung gebracht, wobei das zentrale Nervensystem (ZNS) die zweithäufigste Infektionsstelle ist; die Infektion erfolgt in der Regel durch die Verbreitung vom primären pulmonalen Streuherd [4, 5]. Eine Beteiligung des ZNS kann bei 3–26% der Patienten mit Nokardiose festgestellt werden [17]. Die Identifikation von Nocardia ist jedoch äußerst schwierig, da Kliniker noch kein umfassendes Verständnis bezüglich der Nokardiose besitzen und die Kultur von Nocardia kompliziert ist.…”