[Nocardial brain abscess: surgery and postoperative antibiotic therapy].
Nocardial infections in an immunocompromised host have been increasingly reported. Nocardial brain abscess, the most common presentation of nocardiosis in the central nervous system, is associated with a high mortality rate because of its delayed diagnosis and its unresponsiveness to the usual antibiotic therapy. We report four patients who experienced a long-term cure of nocardial brain abscess due to treatment by a combination of surgery and postoperative antibiotic therapy; 1 man and 3 women, ages ranging from 43 to 67 years old. Two patients were associated with systemic lupus erythematosus and two with autoimmune hemolytic anemia. Patients underwent surgical aspiration and drainage of brain abscess. Nocardia was identified from the aspirated specimen and postoperative antibiotic therapy for 5-6 weeks was performed using effective antibiotic agents; sulfamethoxazole/trimethoprim (ST), imipenem/cilastatin and minocycline (MINO) in Case 1, ST and MINO in Case 2, erythromycin in Case 3, and panipenem/betamipron and cefotaxime in Case 4. Case 3 and Case 4 with multilobulated brain abscess underwent total excision of the brain abscess. All patients showed successful cure of nocardial brain abscess with no recurrence for the period of 1-8 years. The combination of surgery and postoperative antibiotic therapy provides a good prognosis for nocardial brain abscess.
Department of Neurosurgery, Chiba University Postgraduate School of Medicine, Japan.
Tomoko
T
Yoneyama
Iwao
I
Yamakami
Seiichiro
S
Mine
Naokatu
N
Saeki
Akira
A
Yamaura
Hiroaki
H
Ozaki
Masaru
M
Nakazaki
D000328:Adult; D000368:Aged; D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001922:Brain Abscess / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery*; D002439:Cefotaxime / Q000627:therapeutic use; D015377:Cilastatin / Q000627:therapeutic use; D000077728:Cilastatin, Imipenem Drug Combination; D004322:Drainage; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D016867:Immunocompromised Host; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000627:therapeutic use; D009617:Nocardia Infections / Q000188:drug therapy* / Q000601:surgery*; D011182:Postoperative Care; D013845:Thienamycins / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D015091:beta-Alanine / Q000031:analogs & derivatives / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D013845:Thienamycins; D015091:beta-Alanine; C075316:panipenem-betamipron; D015377:Cilastatin; D015378:Imipenem; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000077728:Cilastatin, Imipenem Drug Combination; D008911:Minocycline; D002439:Cefotaxime