title: Central nervous system nocardiosis in Queensland: A report of 20 cases and review of the literature.
abstract: Nocardia infection of the central nervous system (CNS) is an uncommon but clinically important disease, often occurring in immunocompromised individuals and carrying a high mortality rate. We present 20 cases of microbiologically proven CNS nocardiosis diagnosed in Queensland from 1997 to 2015 and review the literature from 1997 to 2016.Over 50% of cases occurred in immunocompromised individuals, with corticosteroid use posing a particularly significant risk factor. Nine (45%) patients were immunocompetent and 3 had no comorbidities at time of diagnosis. Nocardia farcinica was the most frequently isolated species (8/20) and resistance to trimethoprim-sulfamethoxazole (TMP-SMX) was found in 2 isolates. Overall, 35% of our patients died within 1 year, with the majority of deaths occurring in the first month following diagnosis. Interestingly, of the 7 deaths occurring at 1 year, 6 were attributed to N farcinica with the seventh isolate being unspeciated, suggesting the virulence of the N farcinica strain.
authors.affiliation: Monash Medical Centre, Melbourne, VIC, Australia Department of Biomedical and Clinical Sciences Luigi Sacco, III Division of Infectious Diseases, Luigi Sacco Hospital, University of Milan, Milan, Italy The University of Queensland, UQ Centre for Clinical Research, Royal Brisbane & Women's Hospital, Herston, QLD, Australia Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy Department of Microbiology, Pathology Queensland, Royal Brisbane & Women's Hospital, Herston Wesley Medical Research, Auchenflower, QLD, Australia.
authors.forename: Nastaran
authors.initials: N
authors.lastname: Rafiei
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Peri
authors.forename: Elda
authors.initials: E
authors.lastname: Righi
authors.forename: Patrick
authors.initials: P
authors.lastname: Harris
authors.forename: David L
authors.initials: DL
authors.lastname: Paterson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020806:Central Nervous System Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009617:Nocardia Infections / Q000175:diagnosis / Q000188:drug therapy; D011793:Queensland; D012189:Retrospective Studies