Nocardiosis of the Central Nervous System

Krueger, Erich G.; Norsa, Luigia; Kenney, Michael; Price, Pliny A.

doi:10.3171/jns.1954.11.3.0226

Cited by 59 publications

(18 citation statements)

References 10 publications

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“…The most common sites of infection are the lungs, central nervous system, and skin (3). A central nervous system infection usually implies single or multiple brain abscesses, yet meningitis has been reported alone (14). Intracerebral nocardiosis, in contrast to other forms of nocardiosis in the immunologically incompetent patient, can be a rapidly progressive and fulminant infection and has been associated with mortality rates of up to 90% (15).…”

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confidence: 99%

Therapy of experimental cerebral nocardiosis with imipenem, amikacin, trimethoprim-sulfamethoxazole, and minocycline

Gombert¹,

Aulicino²,

duBouchet³

et al. 1986

Antimicrob Agents Chemother

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A mouse model of cerebral nocardiosis was used to determine relative antibiotic efficacy by reducing bacterial colony counts per gram of brain tissue. The antimicrobial agents employed were demonstrated in vitro to be inhibitory to most strains of Nocardia asteroides at very low concentrations. The agents used in this study were imipenem-cilastatin, amikacin, trimethoprim-sulfamethoxazole, and minocycline. Antibiotics were administered every 4 h for 72 h before animal sacrifice. Bacterial colony counts were assayed at various time points before the completion of therapy. Imipenem-cilastatin and amikacin were the most effective agents tested. Trimethoprim-sulfamethoxazole was less effective than imipenem and amikacin but more effective than minocycline. Minocycline did not eradicate intracerebral organisms and was similar to saline (control) in its effects.Nocardia asteroides is being increasingly recognized as a pathogen of normal and immunologically incompetent hosts (7,19). The most common sites of infection are the lungs, central nervous system, and skin (3). A central nervous system infection usually implies single or multiple brain abscesses, yet meningitis has been reported alone (14). Intracerebral nocardiosis, in contrast to other forms of nocardiosis in the immunologically incompetent patient, can be a rapidly progressive and fulminant infection and has been associated with mortality rates of up to 90% (15). Therapy for all forms of nocardiosis usually consists of a sulfonamide alone or in fixed combination with trimethoprim and these have been advocated by some authors as the drugs of choice (20,22). There are reports of cures with other antibiotics for those patients who have either failed on sulfonamides or experienced serious side effects which resulted in therapy being discontinued. These antibiotic regimens have included minocycline (23), amikacin, ampicillin (6), and erythromycin in combination with other agents (2). These alternative forms of therapy usually have been based on in vitro susceptibility testing of the specific strain of N. asteroides isolated from the patient and on previous anecdotal reports.Recent as this represents one of the more common forms of treatment and would provide a basis for comparison with other agents. MATERIALS AND METHODSAnimals. Female Swiss Webster mice weighing approximately 20 g were used in this study. The animals were received from Charles River Breeding Laboratories, Inc., Wilmington, Mass., at 6 weeks of age and were used several days thereafter. The mice were housed in standard cages and fed food and water ad libitum.Bacteria. A strain of N. asteroides isolated from a patient with cerebral nocardiosis at the Downstate Medical Center was used throughout this study. The isolate was maintained on Sabouraud agar slants and transfers to new agar slants were performed periodically. Inoculum preparation was performed by the method of Beaman and Maslan (5)

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confidence: 99%

Therapy of experimental cerebral nocardiosis with imipenem, amikacin, trimethoprim-sulfamethoxazole, and minocycline

Gombert¹,

Aulicino²,

duBouchet³

et al. 1986

Antimicrob Agents Chemother

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“…Although effective in systemic nocardiosis, sulfonamides failed to avert the fatal outcome of brain abscesses. Successful management was only achieved after surgical therapy was added for the first time in 1952 [33]. In the few recent reports on successful medical treatment of nocardia brain abscess, sulfonamides was always supplemented with other antibiotics and persistent and complicated courses were the rule (31,55).…”

Section: Discussionmentioning

confidence: 99%

“…[11,18,33]. Pure nocardial meningitis [14,18,28] or spinal involvement [15,61] are rather rare conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Between EPPItqGZg'fi first description of cerebral nocardiosis in 1890 [14] and 1954 all reported patients except one case of meningitis [28] succumbed this disease. KRUEGEg et al [33] published a report of the first patient with nocardial brain abscess successfully treated by excision combined with antibiotic therapy. Since then several similar cases have been reported, but the mortality rate is still cited as being as high as 80% [11,59].…”

Section: Introductionmentioning

confidence: 99%

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Nocardial cerebral abscess cured with imipenem/amikacin and enucleation

et al. 1989

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A 72 year old female with cerebral abscess due to Nocardia farcinica is reported. Needle aspiration, antimicrobial therapy using a new combination of imipenem and amikacin, and, finally, surgical excision led to prompt and complete recovery. This is the oldest patient to survive cerebral nocardiosis reported in the literature. This infection, is usually regarded as opportunistic and is encountered with increasing frequency in immunocompromised conditions (organ transplantation, chemotherapy, underlying disabling disorder, acquired immunodeficiency syndrome, etc.). The literature is extensively reviewed for various aspects of this disease including prognostic factors, recent developments in antibiotic therapy (imipenem, amikacin, minocycline etc.) and the essential role of surgery in the treatment strategy.

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“…3,8,19) Cerebral nocardi osis is the primary event in only 7% of all cases of nocardiosis. Nocardia brain abscess accounts for only 1% to 2% of all brain abscesses.…”

Section: Discussionmentioning

confidence: 99%

Intraventricular Rupture of Nocardia Brain Abscess-Case Report-

Oshiro

Ohnishi

Ohta

et al. 2003

Neurol. Med. Chir.(Tokyo)

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A 71yearold male presented with left hemiparesis and confused conversation. Computed tomography showed a mass lesion with rim enhancement in the right parietal lobe. He developed meningeal irrita tion the day after admission. Emergent fluidattenuated inversion recovery (FLAIR) magnetic resonance (MR) imaging revealed a clear hyperintense component in the right lateral ventricle and niveau formation inside the intracerebral lesion, indicating intraventricular rupture of the brain abscess. The patient underwent aspiration of the abscess and ventricular drainage with antibiotic administration. Nocardia asteroides was isolated from the aspirated pus, so systemic and direct administration of effective antibiotics was subsequently commenced. These procedures resulted in gradual improvement of his clinical course, and he left our hospital. Several days after discharge, he developed acute panperitonitis due to malignant lymphoma. He appeared to be progressively deteriorating after an exploratory laparotomy, and died on the 17th day after the laparotomy. Intraven tricular rupture of nocardia brain abscess can be successfully treated after early definitive diagnosis with FLAIR MR imaging.

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Nocardiosis of the Central Nervous System

Cited by 59 publications

References 10 publications

Therapy of experimental cerebral nocardiosis with imipenem, amikacin, trimethoprim-sulfamethoxazole, and minocycline

Therapy of experimental cerebral nocardiosis with imipenem, amikacin, trimethoprim-sulfamethoxazole, and minocycline

Nocardial cerebral abscess cured with imipenem/amikacin and enucleation

Intraventricular Rupture of Nocardia Brain Abscess-Case Report-

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