Disseminated Infection of the Central Nervous System Caused by Nocardia farcinica

Miksits, K.; Stoltenburg, G.; Neumayer, H.-H.; Spiegel, Hans; Schaal, K. P.; Cervós-Navarro, J; Distler, Alfiya; Stein, H; Hahn, Helmut

doi:10.1093/ndt/6.3.209

Cited by 22 publications

(11 citation statements)

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“…Thus, when lesions are found at two or more locations within the body, the infection is defined as systemic or disseminated nocardiosis. Any anatomic location can be involved, but the most common sites that become infected during dissemination include the CNS, cutaneous and subcutaneous tissues, eyes (especially the retina), kidneys, joints, bone, and heart (22,26,36,51,105,107,122,135,144,149,156,159,176,191,218,220,251,253,254,260,263,304,352,375,391,392,423,454,459,466,478,479,503,520,522,525,538,540,566,569,585,589,601,631,708,719,731,734).…”

Section: Pulmonary Nocardiosismentioning

confidence: 99%

Nocardia species: host-parasite relationships

1994

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The nocardiae are bacteria belonging to the aerobic actinomycetes. They are an important part of the normal soil microflora worldwide. The type species, Nocardia asteroides, and N. brasiliensis, N. farcinica, N. otitidiscaviarum, N. nova, and N. transvalensis cause a variety of diseases in both normal and immunocompromised humans and animals. The mechanisms of pathogenesis are complex, not fully understood, and include the capacity to evade or neutralize the myriad microbicidal activities of the host. The relative virulence of N. asteroides correlates with the ability to inhibit phagosome-lysosome fusion in phagocytes; to neutralize phagosomal acidification; to detoxify the microbicidal products of oxidative metabolism; to modify phagocyte function; to grow within phagocytic cells; and to attach to, penetrate, and grow within host cells. Both activated macrophages and immunologically specific T lymphocytes constitute the major mechanisms for host resistance to nocardial infection, whereas B lymphocytes and humoral immunity do not appear to be as important in protecting the host. Thus, the nocardiae are facultative intracellular pathogens that can persist within the host, probably in a cryptic form (L-form), for life. Silent invasion of brain cells by some Nocardia strains can induce neurodegeneration in experimental animals; however, the role of nocardiae in neurodegenerative diseases in humans needs to be investigated.

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Section: Pulmonary Nocardiosismentioning

confidence: 99%

Nocardia species: host-parasite relationships

1994

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“…Recently, comprehensive identification tests carried out on clinical isolates of Nocardia have confirmed its higher occurrence in the USA (19%) [9], France (25%) [22] and Ger many (57%) [23], Since N. farcinica isolates are resistant to gentamicin, tobramycin, the third-generation cephalosporins and tetracyclines [9], empiric therapy directed against N. asteroides may not be adequate and thus it may account for high er mortality [22,23], Therefore, antibiotic susceptibility testing should be performed on all Nocardia isolates. While sulfonamides re main the drug of choice for N. farcinica infec tion, amikacin in combination with imipe nem or ampicillin plus clavulanic acid should be used in sulfonamide-resistant cases [15,18,19]. Our report emphasizes that N. farcinica infections are more common than the current literature suggests.…”

Section: Discussionmentioning

confidence: 83%

“…The spectrum of infection included lung involvement in 7, brain in 4, and skin in 3 cases. Four more cases of N. farcinica infec tion have since been described, 2 in AIDS patients [17,18] and 1 each in kidney and heart transplant recipients [ 19,20], This is the 2nd patient in Kuwait found to have N. far cinica infection. The 1st case occurred in a renal transplant recipient and the isolate was susceptible to imipenem and amikacin [21].…”

Section: Discussionmentioning

confidence: 99%

Nocardia farcinica Septicemia in a Patient with Hodgkin’s Disease and Literature Review

Mokaddas¹,

Patel²,

Khan³

et al. 1996

Med Principles Pract

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A case of Nocardia farcinica septicemia in a Kuwaiti female with Hodgkin’s disease is described. The diagnosis was established by the isolation of N. farcinica from blood on two occasions. Her symptoms included fever, dry cough, cutaneous and neurological manifestations. Chest X-rays revealed progressive pneumonitis. The disease ran a very rapid course and the patient died within 4 weeks following the onset of respiratory symptoms despite treatment with cefotaxime to which the organism was later found to be resistant. The delay in the diagnosis of the case was probably due to the masking of clinical manifestations of nocardiosis by the preexistence of Hodgkin’s disease and the subsequent development of herpetic eruptions. N. farcinica appears to cause a more fulminant infection in immunosuppressed patients than do other species of the genus. The report emphasizes that all Nocardia isolates should be adequately identified and subjected to antimicrobial susceptibility testing, so as to make the therapeutic regimen more efficacious. Infections due to N. farcinica appear to be far more prevalent than the current literature suggests.

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“…In any case N. asteroides is by far the most common Nocardia species causing human disease. Nocardia farcinica has only been reported once previously with a fatal outcome [13]. To our knowledge, this is the first case of a brain abscess caused by N. otitidiscaviarum.…”

Section: Discussionmentioning

confidence: 88%

Intracerebral Abscess Caused by Nocardia otitidiscaviarum in a Renal Transplant Patient – Cured by Evacuation plus Antibiotic Therapy

Hartmann¹,

Halvorsen²,

Jenssen³

et al. 2000

Nephron

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We present a 50-year-old female who experienced generalized convulsion 3 months after a successful cadaveric renal transplantation. The first cerebral CT scan indicated cerebral frontal infarction. Repeat CT some days later revealed progressive lesions, and a highly malignant tumor or abscess was suspected. Antifungal and broad-spectrum antibacterial therapy was initiated. Cerebral MRI could not differentiate between these conditions, but a neutrophil granulocyte scan strongly suggested an infectious process. A stereotactic puncture of the frontal lobe was followed by temporary improvement. A severe progressive left-sided hemiparalysis gave indication for a craniotomy with evacuation of the abscess 9 days later. Culture of aspirated pus yielded growth of a gram-positive, rod-shaped bacterium, later identified as Nocardia otitidiscaviarum by sequencing the 16S rRNA. The patient was treated with meropenem plus rifampicin intravenously for 6 weeks followed by oral ciprofloxacin and rifampicin for 2 months. Due to pharmacokinetic interaction with rifampicin, the prednisolone dose was doubled, and the dose of tacrolimus had to be tripled for maintenance of adequate trough concentrations. Five months following cessation of antibiotic treatment, the patient has regained normal strength and function in her left-sided extremities and has a serum creatinine level of about 160 µmol/l (1.8 mg/dl).

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Disseminated Infection of the Central Nervous System Caused by Nocardia farcinica

Cited by 22 publications

References 0 publications

Nocardia species: host-parasite relationships

Nocardia species: host-parasite relationships

<i>Nocardia farcinic</i><i>a</i> Septicemia in a Patient with Hodgkin’s Disease and Literature Review

Intracerebral Abscess Caused by <i>Nocardia otitidiscaviarum</i> in a Renal Transplant Patient – Cured by Evacuation plus Antibiotic Therapy

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Disseminated Infection of the Central Nervous System Caused by Nocardia farcinica

Cited by 22 publications

References 0 publications

Nocardia species: host-parasite relationships

Nocardia species: host-parasite relationships

<i>Nocardia farcinic</i><i>a</i> Septicemia in a Patient with Hodgkin&rsquo;s Disease and Literature Review

Intracerebral Abscess Caused by <i>Nocardia otitidiscaviarum</i> in a Renal Transplant Patient – Cured by Evacuation plus Antibiotic Therapy

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<i>Nocardia farcinic</i><i>a</i> Septicemia in a Patient with Hodgkin’s Disease and Literature Review