title: Diagnosis of Nocardia paucivorans central nervous system infection by DNA sequencing from paraffin-embedded tissue.
abstract: Infections by Nocardia spp. are generally regarded as opportunistic diseases in immunocompromised patients, but can also affect immunocompetent subjects. Such infections represent an important diagnostic challenge for clinicians and microbiologists, and diagnosis is frequently delayed or even conducted post mortem. A 54-year-old man was admitted to our hospital because of ventriculitis and relapsing brain abscess. Five months prior, this patient had undergone external ventricular drain and surgery for a cerebellar abscess. Histopathology demonstrated pyogenic inflammatory reaction, microbiologic investigations proved negative and empiric antimicrobial therapy was administered for a total of eight weeks. Six weeks later, the patient developed relapsing neurologic manifestations. On reviewing the patient's clinical history it emerged that the patient had suffered pneumonia two months prior to neurosurgery, treated with amoxicillin/clavulanate 3g a day and levofloxacin 500mg a day for three weeks. On the CNS relapsing manifestations, nocardiosis was suspected and DNA sequencing from the formalin-fixed paraffin-embedded cerebellar tissue collected during neurosurgery allowed diagnosis of Nocardia paucivorans infection. The patient received medical therapy for 11 months. At follow-up, eight months after treatment was discontinued, the patient was aymptomatic. Nocardia spp. infections need to be suspected not only in immunocompromised, but also in immunocompetent patients. Proper samples need to be collected for proper microbiologic investigations. Paraffin-embedded tissue genomic sequencing can be a useful tool for diagnosis of nocardiosis.
authors.affiliation: Unit of Infectious Diseases, University of Perugia, Perugia, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Schiaroli
authors.affiliation: Unit of Infectious Diseases, University of Perugia, Perugia, Italy.
authors.forename: Maria Bruna
authors.initials: MB
authors.lastname: Pasticci
authors.affiliation: Institute of Microbiology, Catholic University of the Sacred Heart, Gemelli Hospital, Rome, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: De Carolis
authors.affiliation: Institute of Microbiology, Catholic University of the Sacred Heart, Gemelli Hospital, Rome, Italy.
authors.forename: Enrica
authors.initials: E
authors.lastname: Mello
authors.affiliation: Unit of Infectious Diseases, University of Perugia, Perugia, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Pallotto
authors.affiliation: Unit of Microbiology, University of Perugia, Perugia, Italy.
authors.forename: Christian
authors.initials: C
authors.lastname: Leli
authors.affiliation: Unit of Infectious Diseases, University of Perugia, Perugia, Italy.
authors.forename: Giuseppe Vittorio
authors.initials: GV
authors.lastname: De Socio
authors.affiliation: Unit of Infectious Diseases, University of Perugia, Perugia, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Baldelli
authors.affiliation: Institute of Microbiology, Catholic University of the Sacred Heart, Gemelli Hospital, Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Sanguinetti
authors.affiliation: Unit of Microbiology, University of Perugia, Perugia, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Mencacci
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D002526:Cerebellar Diseases / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D058565:Cerebral Ventriculitis / Q000000981:diagnostic imaging / Q000382:microbiology*; D003131:Combined Modality Therapy; D057210:Delayed Diagnosis; D004322:Drainage; D006801:Humans; D007121:Immunocompetence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009615:Nocardia / Q000235:genetics / Q000302:isolation & purification*; D009617:Nocardia Infections / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology / Q000628:therapy; D016612:Paraffin Embedding; D018410:Pneumonia, Bacterial / Q000150:complications; D012008:Recurrence; D017422:Sequence Analysis, DNA; D013530:Surgical Wound Infection / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents