epiglucan and Brain-Abscess

Topics: Abscess; Adult; Antifungal Agents; beta-Glucans; Brain Abscess; Central Nervous System Infections; Dexamethasone; Fresh Water; Humans; Invasive Fungal Infections; Lung Abscess; Magnetic Resonance Imaging; Male; Micafungin; Near Drowning; Pneumonia, Aspiration; Scedosporium; Spinal Cord Diseases; Tomography, X-Ray Computed; Voriconazole

β-D-glucan (BDG) is a helpful diagnostic marker for many invasive fungal infections, but not for nocardiosis. Here, we reported the first case of nocardial infection with high serum level of BDG.. A 73-year-old man was hospitalized because of fever, headache, and appetite loss after 10 months of steroid and immunosuppressive therapy for cryptogenic organizing pneumonia. With a diagnosis of bacterial pneumonia, treatment with ampicillin/sulbactam was initiated. There was improvement on chest radiograph, but fever persisted. Further work-up revealed multiple brain abscesses on cranial magnetic resonance imaging (MRI). Serum galactomannan and BDG were elevated at 0.6 index and 94.7 pg/ml, respectively. Voriconazole was initiated for presumed aspergillus brain abscess. However, fever persisted and consciousness level deteriorated. Drainage of brain abscess was performed; based on the Gram stain and Kinyoun acid-fast stain, disseminated nocardiosis was diagnosed. Voriconazole was then shifter to trimethoprim/sulfamethoxazole. The presence of Nocardia farcinica was confirmed by the 16S rRNA gene sequence. Treatment course was continued; BDG level normalized after 1 month and cranial MRI showed almost complete improvement after 2 months.. BDG assay is widely used to diagnose invasive fungal infection; therefore, clinicians should be aware that Nocardia species may show cross-reactivity with BDG assay on serum.

Topics: Aged; Ampicillin; Anti-Infective Agents; beta-Glucans; Brain Abscess; Drainage; Humans; Male; Nocardia Infections; Sulbactam; Trimethoprim, Sulfamethoxazole Drug Combination

Cerebral spinal fluid from a patient affected by a brain abscess caused by Nocardia abscessus gave a positive result for (1-3)-β-d-glucan (BG) assay, in absence of any fungal infection. This study aimed to assess whether Nocardia spp. show cross-reactivity with BG assay. All Nocardia spp. analyzed provided positive reactions.

Topics: Aged; beta-Glucans; Brain Abscess; Cross Reactions; Diagnosis, Differential; Female; Humans; Mycoses; Nocardia; Nocardia Infections; Proteoglycans