Nocardial brain abscess.
Nocardial infections, although rare, are challenging for clinicians to treat. The associated mortality rate remains high; such infections usually occur in immunocompromised patients who have predisposing factors such as malignancy, diabetes mellitus, malnutrition and uremia. However, there have been increasing reports of nocardial infections being observed in immunocompetent patients. Nocardial organisms are mostly isolated from plants and soil, and infection occurs most often as a result of inhalation or direct skin inoculation. Nocardial infections disseminate hematogenously from the primary location to distant end organs, including the brain, kidneys, joints and eyes. Sulfonamides are the drug of choice, based on empirical data. Given the high rate of relapse and the characteristic resistance pattern, treatment should be aggressive and continued for months, with antibiotic treatment being adjusted according to the drug sensitivity test. In our institution, there have been three documented patients with a nocardial brain abscess. All patients were treated with surgical evacuation followed by antibiotics. Here, we report on one patient and review the literature.
Lin
Yu-Jun
YJ
Department of Neurosurgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung Hsien, Taiwan lin-yu-jun@yahoo.com.tw
Yang
Ka-Yen
KY
Ho
Jih-Tsun
JT
Lee
Tao-Chen
TC
Wang
Hung-Cheng
HC
Su
Feng-Wen
FW
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001921:Brain / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000473:pathology; D001922:Brain Abscess / Q000188:drug therapy* / Q000382:microbiology* / Q000601:surgery; D003937:Diagnosis, Differential; D004334:Drug Administration Schedule; D004678:Encephalomalacia / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D005260:Female; D006801:Humans; D007113:Immunity, Innate / Q000276:immunology; D016867:Immunocompromised Host / Q000276:immunology; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D009617:Nocardia Infections / Q000150:complications* / Q000188:drug therapy* / Q000601:surgery; D009616:Nocardia asteroides / Q000187:drug effects / Q000502:physiology; D010291:Paresis / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D055502:Secondary Prevention; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents