title: Clinical Pathway in the Treatment of Nocardial Brain Abscesses following Systemic Infections.
abstract: Nocardial infections are commonly encountered in patients with immunocompromised states. Cerebral nocardiosis is an uncommon clinical entity, representing only 2% of all cerebral abscesses. It has a higher mortality rate, especially for multiple cerebral lesions in immunocompromised hosts following systemic infections. However, an optimal treatment policy to deal with these immunocompromised patients in Asia is still lacking. We retrospectively reviewed the subjects with nocardial brain abscesses from 2001 to 2011 at our medical center. All of them had multiple brain abscesses, underlying with immunocompromised state following systemic infections. All cases were under steroid control due to their comorbidities for more than six months. The comorbidities and misdiagnosis often lead to poor prognosis. The change in the environments of the microorganisms caused by immunosuppressive agents and multiple antibiotic uses may play an important role in this critical disorder. Aggressive craniotomy should be performed in time to avoid grievous neurological outcomes. Our conclusion is that early diagnosis and appropriate antibiotic uses should be implemented promptly, and aggressive craniotomy should be performed for nocardial brain abscesses in subjects with systemic infections under an immunocompromised status.
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan.
authors.forename: Yun-Cong
authors.initials: YC
authors.lastname: Zheng
authors.affiliation: Department of Neurosurgery, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Tse-Lun
authors.identifier: 0000-0002-2395-8655
authors.initials: TL
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan.
authors.forename: Jee-Ching
authors.initials: JC
authors.lastname: Hsu
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan.
authors.forename: Yung-Hsing
authors.initials: YH
authors.lastname: Hsu
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan.
authors.forename: Wen-Hsing
authors.initials: WH
authors.lastname: Hsu
authors.affiliation: Department of Chest, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan.
authors.forename: Chih-Liang
authors.identifier: 0000-0003-2917-8307
authors.initials: CL
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Aij-Lie
authors.initials: AL
authors.lastname: Kwan
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan.
authors.forename: Chih-Lung
authors.identifier: 0000-0003-0649-4243
authors.initials: CL
authors.lastname: Lin