Isolation of Nocardia paucivorans from the Cerebrospinal Fluid of a Patient with Relapse of Cerebral Nocardiosis

Abstract

Nocardia paucivorans represents a new species of the genus Nocardia that has recently been isolated from bronchial secretions of a patient with chronic lung disease. Here, we report on the course of a disseminated infection caused by this species: i.e., cerebral and subsequent meningeal manifestations, isolation from the cerebrospinal fluid, and in vitro susceptibility to various antimicrobial agents

Clinical and Laboratory Features of theNocardiaspp. Based on Current Molecular Taxonomy

“…Eisenblätter and colleagues described a case of N. paucivorans meningitis in a patient with underlying chronic lung disease (53).…”

“…Other common sites of nocardial dissemination include skin, subcutaneous tissues, and the central nervous system (53,61,106,110,188). Unusual extrapulmonary manifestations include N. farcinica infection of sternotomy sites following open heart surgery (219), N. asteroides complex peritonitis following continuous ambulatory peritoneal dialysis in a patient with systemic lupus erythematosus and chronic renal failure (128), and N. asteroides complex endopthalmitis in transplant recipients receiving corticosteroid therapy (113).…”

Nocardiosis

“…It is now known that many of the invasive infections thought to have been caused by N. brasiliensis were actually caused by a more recently recognized species, N. pseudobrasiliensis (17). Newly recognized species such as N. africana, N. paucivorans, and N. veterana have also been reported to cause disease in humans, although little is known of their epidemiology (6,8,13).…”

Nocardia veterana Isolated from Ascitic Fluid of a Patient with Human Immunodeficiency Virus Infection

“…Indeed, five new Nocardia species recovered from human samples have been characterized since 2000: N. abscessus (31), N. africana (12), N. cyriacigeorgici (32), N. paucivorans (30), and N. veterana (11). Most of them are implicated in infectious processes: strains belonging to N. africana, N. cyriacigeorgici, and N. paucivorans were isolated from sputa or bronchial secretions of patients with pulmonary infections; N. paucivorans was also reported to have been isolated from the cerebrospinal fluid of a patient with relapse of cerebral nocardiosis (10) and from the central nervous system biopsy specimen of a patient with brain abscesses (28), and N. abscessus was isolated from various abscesses (31) and from a pericardial aspirate (28). Little is known about N. veterana, since only three isolates have been published.…”

“…Infection is commonly introduced through the respiratory tract, and pulmonary disease is the most common presentation. Hematogenous dissemination can occur, mainly involving the nervous system and skeletal soft-tissue structures (10,20). However, some unusual locations of nocardial infection have been reported (5,16,17).…”