A cluster of nocardial brain abscesses.
BACKGROUND
Nocardia species are aerobic Gram-positive bacteria that are ubiquitous in the environment. Infection usually occurs through inhalation or direct cutaneous inoculation of the organism. It has been reported that infection is more common in warm, dry climates. Cerebral nocardiosis is an uncommon clinical entity, representing only 2% of all cerebral abscesses. It is an illness associated with significant morbidity and mortality.


METHODS
We report 4 cases of nocardial brain abscesses presenting to TCH, Australia, within a 1-year period. All 4 cases occurred in men without any significant underlying immunocompromise. In 3 of the cases, the diagnosis was only established after craniotomy. All cases were given prolonged antimicrobial therapy. After more than 8 months of follow-up, there have been no deaths or treatment failures. There has been only one other case of nocardial brain abscess at TCH over the past 15 years. We review the current literature on cerebral nocardiosis.


CONCLUSIONS
Nocardial brain abscesses are uncommonly encountered at our institution. This cluster of 4 cases over a 1-year period has therefore led us to postulate that the severe drought may be aiding in the transmission of the bacteria. The cases also emphasize the propensity of nocardial infections to mimic other conditions, particularly malignancy, which may lead to delays in appropriate surgical treatment and antimicrobial therapy. The diagnosis requires a high clinical index of suspicion, with early tissue and microbiological diagnosis. Prolonged antimicrobial therapy is required to prevent relapse of the infection.
Kennedy
Karina J
KJ
Department of Infectious Diseases, The Canberra Hospital, Australian Capital Territory 2606, Australia. karina.kennedy@act.gov.au
Chung
K H Carlos
KH
Bowden
Francis J
FJ
Mews
Peter J
PJ
Pik
Justin H T
JH
Fuller
John W
JW
Chandran
K Nadana
KN
D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001922:Brain Abscess / Q000382:microbiology* / Q000601:surgery; D016000:Cluster Analysis; D003399:Craniotomy; D003949:Diagnostic Techniques, Surgical; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009617:Nocardia Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D009616:Nocardia asteroides / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed
D000890:Anti-Infective Agents