Nocardial brain abscess: Review of clinical management

Kılınçer, Cumhur; Hamamcıoğlu, Mustafa Kemal; Şimşek, Osman; Hiçdönmez, Tufan; Aydoslu, Bayram; Tansel, Özlem; Tiryaki, Mehmet; Soy, Mehmet; Tatman‐Otkun, Müşerref; Çobanoğlu, Sebahattin

doi:10.1016/j.jocn.2005.04.031

Cited by 46 publications

(28 citation statements)

References 27 publications

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“…Leitersdorf et al reported an uneventful recovery in 9 out of 10 transplanted patients treated with minocycline (100 to 600 mg/day) for disseminated nocardiosis, including CNS infections (23). Two more cases of successful maintenance treatment with minocycline at 100 mg/day in patients with nocardial cerebral abscesses have also been reported (11,24). However, a treatment failure has been described in three patients treated with minocycline for pulmonary nocardiosis, with the patients developing brain abscesses under treatment.…”

Section: Case Reportmentioning

confidence: 99%

First Case of Cerebral Abscess Due to a Novel Nocardia Species in an Immunocompromised Patient

et al. 2013

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Section: Case Reportmentioning

confidence: 99%

First Case of Cerebral Abscess Due to a Novel Nocardia Species in an Immunocompromised Patient

et al. 2013

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“…(4) However, other manifestations, such as cutaneous or cerebral infection with cellulitic nodular changes and abscesses that lead to space-occupying, lesion-like presentations, have also been documented in the literature. (5,6) The primary challenge with nocardiosis is in arriving at a diagnosis. Although well-reported in the medical literature, the relative rarity of this infection can lead to it being overlooked and misdiagnosed as other pathologies.…”

Section: Introductionmentioning

confidence: 99%

A case of systemic nocardiosis in systemic vasculitis and a review of the literature

Sirisena¹,

Swedan²,

Jayne³

et al. 2013

smedj

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Systemic nocardiosis is rarely reported in patients with systemic vasculitis, and is mostly described in patients experiencing long-term immunosuppression following organ transplantation. In this report, we describe a 71-year-old man who developed disseminated Nocardia infection during treatment of his underlying microscopic polyangiitis. He had no other associated risk factors. This case highlights the importance of considering rare pathogens in immunosuppressed patients who present with nonspecific symptoms, as well as the impact of such pathogens on clinical management.

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“…The authors concluded that, in view of the isolation frequency, the invasiveness, and the lowest susceptibility to antimicrobials, N. farcinica is the most pathogenic of the Nocardia species (29). The mortality rates for nocardial abscesses are higher than those for most other brain abscesses, being 55% in immunocompromised patients and 20% in immunocompetent patients (30,31).…”

Section: Discussionmentioning

confidence: 99%

Creation of an In-House Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry Corynebacterineae Database Overcomes Difficulties in Identification of Nocardia farcinica Clinical Isolates

et al. 2015

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e Nocardiosis is a rare disease that is caused by Gram-positive actinobacteria of the Nocardia genus and affects predominantly immunocompromised patients. In its disseminated form, it has a predilection for the central nervous system and is associated with high mortality rates. Therefore, prompt identification of the pathogen is critical. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry is a relatively novel technique used for identification of microorganisms. In this work, an upgraded MALDI-TOF Biotyper database containing Corynebacterineae representatives of strains deposited in the Polish Collection of Microorganisms was created and used for identification of the strain isolated from a nocardial brain abscess, mimicking a brain tumor, in an immunocompetent patient. Testing with the API Coryne system initially incorrectly identified Rhodococcus sp., while chemotaxonomic tests, especially mycolic acid analysis, enabled correct Nocardia identification only at the genus level. Subsequent sequence analysis of 16S rRNA and secA1 genes confirmed the identification. To improve the accuracy of the results, an in-house database was constructed using optimized parameters; with the use of the database, the strain was eventually identified as Nocardia farcinica. Clinical laboratories processing various clinical strains can upgrade a commercial database to improve and to accelerate the results obtained. This is especially important in the case of Nocardia, for which valid microbial diagnosis remains challenging; reference laboratories are often required to identify and to survey these rare actinobacteria.N ocardia represents Gram-positive actinobacteria that are etiological agents of the rare disease nocardiosis, which affects predominantly immunocompromised patients. Nocardiosis usually presents itself as a solitary lesion located in lung, skin, or brain (primary nocardiosis), but sometimes disseminated nocardiosis with multiple sites is observed. Nocardia spp. show a marked predilection for the central nervous system (CNS) (1).Nocardiosis of the CNS constitutes about 40% of all cases of disseminated nocardioses and is associated with high mortality rates. The true incidence of Nocardia infections is difficult to assess, because of problems with the identification of these bacteria. Many different phenotypic, chemotaxonomic, or genotyping methods are available, but each method possesses drawbacks; for this reason, fast reliable identification of Nocardia isolates is very important. Because Nocardia spp. differ in antibiotic susceptibility, correct identification of clinical strains is critical for adequate treatment.Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (MS) has been introduced for microbial identification in the past few years. Its reliability, accuracy, and cost-effectiveness have been well described in the literature (2-4). This method can be used to identify microorganisms from all domains of life, i.e., Archaea, Bacteria, and E...

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Nocardial brain abscess: Review of clinical management

Cited by 46 publications

References 27 publications

First Case of Cerebral Abscess Due to a Novel Nocardia Species in an Immunocompromised Patient

First Case of Cerebral Abscess Due to a Novel Nocardia Species in an Immunocompromised Patient

A case of systemic nocardiosis in systemic vasculitis and a review of the literature

Creation of an In-House Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry Corynebacterineae Database Overcomes Difficulties in Identification of Nocardia farcinica Clinical Isolates

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