Clinical Pathway in the Treatment of Nocardial Brain Abscesses following Systemic Infections

Abstract

Nocardial infections are commonly encountered in patients with immunocompromised states. Cerebral nocardiosis is an uncommon clinical entity, representing only 2% of all cerebral abscesses. It has a higher mortality rate, especially for multiple cerebral lesions in immunocompromised hosts following systemic infections. However, an optimal treatment policy to deal with these immunocompromised patients in Asia is still lacking. We retrospectively reviewed the subjects with nocardial brain abscesses from 2001 to 2011 at our medical center. All of them had multiple brain abscesses, underlying with immunocompromised state following systemic infections. All cases were under steroid control due to their comorbidities for more than six months. The comorbidities and misdiagnosis often lead to poor prognosis. The change in the environments of the microorganisms caused by immunosuppressive agents and multiple antibiotic uses may play an important role in this critical disorder. Aggressive craniotomy should be performed in time to avoid grievous neurological outcomes. Our conclusion is that early diagnosis and appropriate antibiotic uses should be implemented promptly, and aggressive craniotomy should be performed for nocardial brain abscesses in subjects with systemic infections under an immunocompromised status.

Nocardiosis in the south of France over a 10-years period, 2004–2014

“…Several cases of isolated brain abscess have been reported in the literature, but often with poor information on radiological staging. [24][25][26] The strategy for radiological staging was unfortunately heterogeneous and depended on the medical staff. In visceral nocardiosis, especially in immunocompromised patients, a systematic examination including blood cultures, CAP-CT, and head CT should be performed.…”

Cryptic Nocardia nova brain abscess postradiation treatment and neurosurgery in a patient with small cell lung cancer: A case report and review of the literature

“…Nocardiosis of the central nervous system is a rare cause of cerebral abscesses, accounting for only approximately 2% or 30 to 50 annual cases 7 . The subject in this case carried several risk factors for Nocardia brain abscess, including long-term corticosteroid therapy, chemotherapy-induced leukopenia, and previous brain pathology.…”

“…Nocardiosis of the central nervous system is a rare cause of cerebral abscesses, accounting for only approximately 2% or 30 to 50 annual cases. 7 The subject in this case carried several risk factors for Nocardia brain abscess, including long-term corticosteroid therapy, chemotherapy-induced leukopenia, and previous brain pathology. Clinical diagnosis is difficult because the presentation mimics other brain pathology and classic signs and symptoms of infection (ie, fever) are often hidden in immunocompromised patients.…”

Nocardiosis: A Neglected Disease

“…Ninan et al [32], 2016 South India 131 cases: N. asteroides (73), Nocardia spp. (32), N. brasiliensis (2), aerobic actinomycetes (24) Skin (36), eye (36), pulmonary (35), immunosuppressive therapy (48) Nampoory et al [47], 1996 Kuwait 6 cases: N. asteroides (4), N. otitidiscaviarum (1), N. farcinica (1) Pulmonary nocardiosis (3: with 2 cerebral abscess, 1 meningitis); perinephric abscess (1), thigh abscess (1), ischiorectal abscess (1) Lai et al [65], 2011 Taiwan 138 isolates: N. brasiliensis (58), N. cyriacigeorgica (22), N. farcinica (11), N. beijingensis (8), N. otitidiscaviarum (7), N. nova (6), N. puris (6), N. asiatica (5), N. flavorosea (5), N. abscessus (3), others 7Skin and soft-tissue, respiratory tract specimens, brain biopsy, blood, lymph node…”

“…For CNS nocardiosis, based on recommendations by various authors [73][74][75], it can be concluded that for clinically stable patients with a brain abscess < 2 cm, treatment should be initiated with a long-term antibiotic, initially intravenously for 4-6 weeks followed by oral therapy for 6-12 months with or without aspiration of abscess. Aspiration helps to relieve mass effect and aid in definitive laboratory diagnosis.…”