Nocardia paucivorans cerebellar abscess: Surgical and pharmacotherapy

Abstract

Background:Nocardia species are ubiquitous in nature and mainly cause pulmonary disease in humans; however, they can also infect the central nervous system and skin. The management of cerebellar nocardiosis is troublesome and requires multiple considerations of the severity of the underlying systemic disease, difficulties in identifying the bacterium, and frequent delay in initiating adequate therapy.Case Description:We report a 52-year-old diabetic female patient with Nocardia paucivorans cerebellar abscesses. Brain magnetic resonance imaging (MRI) revealed innumerable small ring-enhancing lesions of posterior fossa. In this report, we present a case of primary single cerebellar abscesses due to N. paucivorans. Early diagnosis and surgical interventions were significant for the patient. The diagnosis was confirmed by DNA sequencing and the organism was susceptible to trimethoprim–sulfamethoxazole (TMP/SMX). The patient was successfully treated with drugs and surgical excision.Conclusion:According to the literature, surgical excision or aspiration of cerebellar abscess seems to provide favorable outcomes. In our experience, a successful outcome was achieved with subtotal resection and prolonged adequate antibiotic therapy.

Intra-Abdominal Nocardiosis—Case Report and Review of the Literature

“…N. paucivorans was first isolated in sputum in 2000 [ 58 ]. To our knowledge, 49 cases of N. paucivorans infection have been published [ 2 , 3 , 4 , 56 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ], and we summarize these in Table 1 . The majority (33 cases) were reported by Gray et al from Queensland, Australia, and were identified retrospectively via 16S ribosomal DNA sequencing of archived biopsy specimens [ 63 ].…”

“…Unfortunately, the paper by Gray et al lacks details regarding therapy and outcome of most patients, limiting the information to be gained from these cases. Additionally, none of the 49 previously reported cases included detailed information on the presumed route of acquisition of N. paucivorans infection [ 2 , 3 , 4 , 56 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ].…”

“…Nocardia are gram-positive, aerobic, filamentous bacteria that most often cause pulmonary infection in immunosuppressed hosts, while isolated abdominal or retroperitoneal nocardiosis is rare [ 1 ]. In extrapulmonary nocardiosis, malignancy is often suspected due to the presence of abdominal or cerebral masses [ 2 , 3 , 4 , 5 , 6 ], which can lead to misdiagnosis. Additionally, accurate diagnosis may be challenging due to slow growth of nocardia species in culture [ 7 , 8 ].…”

Nocardia spp.: A Rare Cause of Pneumonia Globally

“…179,181 Antimicrobial therapy may be curative, 181 but mortality rates are high (may exceed 40%). In some cases, surgical debridement, drainage, or resection of brain abscesses may be necessary, [182][183][184][185] particularly in those with impaired immunity. 34,175 In one IC patient with brain abscesses and an intracranial aneurysm due to N. abscessus, a combination of antimicrobials and surgical resection of the aneurysm was curative.…”

“…38,183,186,187 Nocardia paucivorans, which rarely causes diseases in humans, appears to have a predilection for CNS involvement and dissemination. 38,184,188 Similarly, N. asiatica 33 and N. farcinica have a proclivity for CNS involvement. 34,178,185,189 Bone Bone involvement is rare in nocardiosis, but spine abscesses, 190 epidural abscesses, 191 paravertebral abscesses, 112 mycetomas of the feet, 168 osteomyelitis, 192 and septic arthritis 100,193 have been described.…”