[Nocardia brain abscess and ventriculitis--resistance of Nocardia to sulfonamides and susceptibility to beta-lactams].
A 31-year-old man had been healthy until the end of August, 1984 when he developed a sore throat, rhinorrhea, and high fever (39 degrees C). He was found to have hematuria and leukocytosis, though his complaints were not severe, and was not absent from his work. From the September 30, he experienced continuous pains on both temple regions and the neck. On October 6, he visited our hospital without any inflammatory signs. A screening CT scan demonstrated a ring-like enhancing mass with remarkable perifocal edema in the right temporal lobe. On emergency admission on October 9, a low grade fever (37.4 degrees C) and slight leukocytosis were noted, but not other primary lesions were present. He had normal immunological function of both humoral and cellular types. A provisional diagnosis of malignant brain tumor was made, but a possibility of brain abscess was not completely ruled out. He was initially treated with antidiuretics and steroid with prophylactic antibiotics, and underwent follow-up CT scanning. After a 10-day period with no obvious changes in CT scan, he suddenly complained of severe headache and fever, and became stuporous. A subsequent CT scan showed signs of ventriculitis, and contrast-enhancing multiloculated capsules. A lumber puncture revealed an increased number of cells, and concentration of protein in the CSF. An emergency trephination and drainage of an abscess was performed. Gram positive, acid fast, and branching fungi were found in both the smear of pus, and the samples from surrounding brain tissues. These were later identified as Nocardia asteroides in bacteriological studies.(ABSTRACT TRUNCATED AT 250 WORDS)
Y
Y
Oda
Y
Y
Kamijyo
Y
Y
Kang
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001922:Brain Abscess / Q000188:drug therapy*; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D008297:Male; D009615:Nocardia / Q000187:drug effects; D009617:Nocardia Infections / Q000188:drug therapy*; D013449:Sulfonamides / Q000494:pharmacology*; D047090:beta-Lactams
D000900:Anti-Bacterial Agents; D013449:Sulfonamides; D047090:beta-Lactams