trimethoprim--sulfamethoxazole-drug-combination and Brain-Abscess

Listeria monocytogenes (L. monocytogenes) is an opportunistic facultative anaerobic pathogen that is widely distributed in nature. Brain infection (meningitis and meningoencephalitis) and bacteremia are common clinical manifestations of listeriosis in elderly and immunocompromised individuals. Brain abscesses caused by L. monocytogenes are extremely rare. In this study, we describe a case of an older male who with a brain abscess caused by Listeria infection.. We report a case of a 59-year-old male who was once diagnosed with acute cerebral infarction. The diagnose was changed after needle biopsy of the abscess and culture of L. monocytogenes. The patient was first empirically used the broad-spectrum antibiotic meropenem for 12 days (2 g Q8 h) until culture results were available, and then switched to oral trimethoprim/sulfamethoxazole 160/800 mg/12 h for further 2 weeks. The symptoms of slurred speech, numbness and impaired muscle strength of the right leg improved. Computed tomography (CT) and magnetic resonance imaging (MRI) examination were performed 2 weeks after operation showed smaller abscess and reduced perifocal edema. The patient was continued oral trimethoprim/sulfamethoxazole for 8 weeks. The remaining right arm dysfunction recovered. After six months, the patient had returned to normal daily activities and only exhibited weakness of the right fingers.. Brain abscess caused by L. monocytogenes should be considered in patients who have risk factors for listeriosis. Pathogen infection, including with Listeria monocytogenes, should be taken into account when patients with impaired immune function exhibit hemiplegia and aphasia. Listeria infection should also be considered in immunocompetent patients. Performing needle biopsy or lesion resection and starting antibiotic therapy according to drug susceptibility testing in the early stage is key to treating this kind of disease.

Topics: Aged; Anti-Bacterial Agents; Brain Abscess; Humans; Listeria monocytogenes; Listeriosis; Male; Microbial Sensitivity Tests; Middle Aged; Mycobacterium tuberculosis; Trimethoprim, Sulfamethoxazole Drug Combination

BACKGROUND Central nervous system infection by the Nocardia species is associated with high morbidity and mortality. Its occurrence in patients with multiple myeloma is rare and acquisition of the infection in such patients was associated with the use of novel therapeutic agents (eg, bortezomib and lenalidomide) or bone marrow transplantation. Here, we report the first case of Nocardia brain abscesses in a patient with multiple myeloma, without the above risk factors. CASE REPORT A 44-year-old woman with IgG-kappa type multiple myeloma presented with generalized tonic-clonic seizures. Magnetic resonance imaging of the brain revealed 3 space-occupying lesions in left frontal, left parietal, and right parietal regions. Craniotomy and enucleation of the left frontal lesion revealed an abscess. The culture result was Nocardia farcinica. The patient was treated with meropenem, amikacin, and trimethoprim-sulfamethoxazole for 6 weeks, followed by trimethoprim-sulfamethoxazole for 12 months, with good outcome. CONCLUSIONS Cerebral nocardiosis is a rare entity and its occurrence in our case may hint toward myeloma-associated humoral immune dysfunction as a pathogenesis and the importance of humoral immunity in the defense against this infection. However, chemotherapy-induced cell-mediated dysfunction cannot be ruled out as a risk factor for the infection. Despite its rarity, this case aims to raise awareness of the condition and reiterate the importance of considering the rare but life-threatening conditions in the differential diagnosis of brain lesions, especially when there is a misdiagnosis of the radiological findings, as occurred in this and previous cases; this avoids delays in appropriate surgical and medical treatment, which can affect outcomes.

Topics: Adult; Amikacin; Antineoplastic Agents; Bortezomib; Brain Abscess; Female; Humans; Immunoglobulin G; Lenalidomide; Meropenem; Multiple Myeloma; Nocardia; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Sulfamethoxazloe-trimethoprim is one of the most frequently used antibiotics in the treatment of Nocardia infection. However, in vitro studies have shown an increase in sulfonamide resistance among Nocardia species. Here, we present a case with a brain abscess caused by Nocardia farcinica in which the test results for drug susceptibility to sulfonamide conflicted with the actual clinical course.\ \ A 74-year-old woman with autoimmune hepatitis who has being treated with oral prednisolone (16 mg/day) was admitted because of headaches and fever. A CT scan and MRI revealed a brain abscess that had ruptured into the lateral ventricle. She was empirically treated with antibiotics, but her condition did not resolve. Therefore, the abscess was drained surgically. Gram and Kinyoun stains for pus revealed a modified acid-fast branching filamentous bacterium consistent with Nocardia species. The pathogen was identified as Nocardia farcinica based on its 16S rRNA sequence. Consequently, the patient was treated with sulfamethoxazole -trimethoprim and amikacin. However, susceptibility testing (broth microdilution method) showed that the strain was completely resistant to sulfamethoxazole-trimethoprim. We therefore changed the therapeutic regimen to imipenem-cilastatin and amikacin, but her symptoms worsened and the treatment was thought to have failed. She was then re-treated with sulfamethoxazole- trimethoprim, and her symptoms resolved. Some reports have suggested that interpreting the results of Nocardia susceptibility testing may be difficult especially the susceptibility of Nocardia to sulfamethoxazole-trimethoprim. The present case suggests a confliction between susceptibility testing and the clinical course of a patient with Nocardia infection.

Topics: Aged; Brain Abscess; Female; Humans; Magnetic Resonance Imaging; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Although disseminated nocardiosis has been increasing with the expansion of immunosuppressive therapy and improvement in diagnostic methods, muscle abscess is a rare complication. There have been only nine case reports of muscle abscess due to Nocardia infection in the English-language published work. We present a case of muscle abscess with disseminated nocardiosis, and review the published work. The patient had been taking prednisolone at 20 mg a day for autoimmune hemolytic anemia for 14 years. She presented with erythema on her thigh resembling cellulitis. Computed tomography showed muscle abscess. The isolated organism was identified as Nocardia farcinica employing polymerase chain reaction and antibiotic sensitivity testing. The diagnosis of muscle abscess due to nocardiosis can be easily missed because there are no characteristic symptoms.

Topics: Abscess; Anemia, Hemolytic, Autoimmune; Anti-Bacterial Agents; Brain Abscess; Female; Humans; Immunosuppressive Agents; Middle Aged; Muscular Diseases; Nocardia; Nocardia Infections; Prednisolone; Trimethoprim, Sulfamethoxazole Drug Combination

Acanthamoeba-related cerebral abscess and encephalitis are rare but usually fatal, being caused by free-living amoebic infections usually occurring in immunocompromised patients. In patients receiving transplants, a literature review showed that the infection is universally fatal. The diagnosis is often missed despite appropriate investigations including lumbar puncture, computerized tomography, and brain biopsy. We present the first reported liver transplant patient with Acanthamoeba cerebral abscess. The diagnosis was made in brain tissue removed at decompressive frontal lobectomy. He was successfully treated with a 3-month course of co-trimoxazole and rifampicin. There was no recurrence of the disease after 11 years of follow-up.

Topics: Acanthamoeba; Adult; Amebiasis; Animals; Antimalarials; Brain Abscess; Combined Modality Therapy; Drug Therapy, Combination; Frontal Lobe; Humans; Immunocompromised Host; Immunosuppressive Agents; Liver Transplantation; Male; Opportunistic Infections; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Central nervous system involvement often follows bacteremia because of Listeria monocytogenes. Meningitis is clinically the most common manifestation, while brain abscess occurs in about 1% of patients. Brain abscess is usually solitary but in recent years, probably in part because of the availability of computerized tomography and magnetic resonance imaging, several reports have described two or more separate supratentorial abscesses.. We have described three patients with listerial brain abscesses and reviewed the North American and European literature of brain abscess(es) because of L. monocytogenes through December 2001. We have evaluated the role of underlying diseases and therapeutic immunosuppression on the development of solitary or greater than one brain abscess.. In contrast to meningitis, where immunosuppression does not predispose either to disease incidence or to higher mortality, patients with solitary and particularly those with more than one supratentorial abscess usually are immunosuppressed either by disease or by therapy. Corticosteroids in particular are significant predisposing factors, especially in those patients with two or more brain abscesses. Mortality resulting from listerial brain abscess, whether solitary or multiple, is nearly three times higher than nonlisterial brain abscess, probably in part because of both underlying diseases and immunosuppressive therapy.. Therapy with high-dose ampicillin in combination with gentamicin appear to be the drugs of choice, followed by trimethoprim/sufamethoxazole and vancomycin. In general, antimicrobial therapy appears to be satisfactory treatment without surgical intervention.

Topics: Adrenal Cortex Hormones; Ampicillin; Anti-Bacterial Agents; Brain Abscess; Humans; Immunocompromised Host; Listeria monocytogenes; Listeriosis; Male; Middle Aged; Penicillins; Prognosis; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Rhodococcus equi brain abscesses usually occur in immunocompromised patients with prolonged and refractory pulmonary infections. Herein we report a case of R. equi brain abscess in a 67-y-old man without immunodepression. Our patient recovered after neurosurgical resection and prolonged antimicrobial therapy with vancomycin and trimethoprim-sulfamethoxazole.

Topics: Actinomycetales Infections; Adolescent; Adult; Aged; Brain Abscess; Drug Resistance; Female; Humans; Immunocompetence; Male; Middle Aged; Rhodococcus equi; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

The successful management of nocardial brain abscess remains problematic. The authors report 11 cases of nocardial brain abscess treated between 1971 and 1993 and review 120 cases reported since 1950. The clinical findings included focal deficits in 55 patients (42%), nonfocal findings in 36 (27%), and seizures in 39 (30%). Extraneural nocardiae were present in 66% of the cases; pulmonary (38%) and cutaneous/subcutaneous (20%) locations were the most frequent. The abscesses were single in 54% of the patients, multiple in 38%, and of unknown number in 8%. Forty-four of 131 patients (34%) were immunocompromised; since 1975, 18 of 40 immunocompromised patients (45%) were transplant recipients and six (15%) had human immunodeficiency virus. The mortality rate was 24% after initial craniotomy and excision (11/45), 50% after aspiration/drainage (17/34), and 30% after nonoperative therapy (7/23); 29 cases (22%) were diagnosed at autopsy. The mortality rate was 33% in patients with single abscesses and 66% in those with multiple abscesses (P < 0.0003). There was no difference in the mortality rates of immunocompromised and nonimmunocompromised patients treated before computed tomography (CT) was available; since the advent of CT, however, the mortality rate has been significantly higher in immunocompromised patients (55% vs. 20%, P < 0.05). Although the mortality rate for nocardial brain abscesses has dropped almost 50% since the advent of CT, it has remained virtually unchanged in immunocompromised patients and is three times higher than that of other bacterial brain abscesses (30% vs. 10%). The authors recommend image-directed stereotactic aspiration for diagnosis; however, craniotomy and total excision are necessary in most cases, because nocardial abscesses are usually multiloculated. Patients with minimal neurological deficits or small abscesses may be treated initially with antibiotics alone. Sulfonamides, alone or in combination with trimethoprim, are most effective and should be continued for at least 1 year. Minocycline, imipenem, or aminoglycoside in combination with a third-generation cephalosporin may be used with reasonably good success as second-line agents in cases of allergy or nonresponsiveness to sulfa agents.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Brain Abscess; Combined Modality Therapy; Craniotomy; Drainage; Female; Humans; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Opportunistic Infections; Survival Rate; Trimethoprim, Sulfamethoxazole Drug Combination

As the case presented here illustrates, nocardiosis, like other infections in which cell-mediated immunity plays a large defensive role, can relapse after apparent cure and occasionally at times remote from the original infection. Although relapse in patients with transplants has been cited as a reason for continued prophylaxis, only a few of these cases are adequately documented. This case supports the advice of those authors who give suppressive antibiotic therapy for the duration of immunosuppression in transplant recipients recovering from infections due to Nocardia sp. Alternatively, many transplant centers are routinely using TMP/SMX chemoprophylaxis in all solid organ transplantations to prevent opportunistic infections with Pneumocystis and Listeria sp. Primary prophylaxis has also been associated with a decreased incidence of nocardial infections.

Topics: Adult; Biopsy; Brain Abscess; Female; Humans; Kidney Transplantation; Magnetic Resonance Imaging; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Pneumonia; Recurrence; Time Factors; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardia is an increasingly important opportunistic pathogen in immunosuppressed patients, especially solid organ transplant recipients. Infection is most often caused by Nocardia asteroides and presents as lung disease in 80% to 90% of infected transplant patients. Radiographic findings are nonspecific and include nodular infiltrates, cavitation, and pleural effusion. Dissemination to other organs, especially to the central nervous system (CNS) and skin, occurs in up to 40% of transplant recipients. A presumptive diagnosis is most rapidly made by the direct visualization in tissue, lower respiratory secretions, or wound drainage of filamentous, gram-positive, beaded rods that are partially acid fast. Specimens for culture should be held for at least 3 weeks when the diagnosis is suspected. The prognosis of nocardial infection is related to the site of disease, rapidity of diagnosis, and extended treatment with a sulfonamide. Mortality is highest in patients with CNS involvement. Prophylactic trimethoprim-sulfamethoxazole should be considered in transplant centers with excess rates of nocardial infection. Hopefully, future refinement of immunosuppressive regimens will be accompanied by a reduction in frequency of Nocardia infections in transplant recipients.

Topics: Brain Abscess; Humans; Lung Diseases; Nocardia Infections; Prognosis; Sulfonamides; Transplantation; Trimethoprim, Sulfamethoxazole Drug Combination

A 25-year-old man, who was slightly immunosuppressed, presented headache and right motor weakness due to multiple brain abscesses disseminated from lung abscess. They were diagnosed, by bacteriological examination, as nocardial brain abscesses (nocardia asteroides) 4 weeks after the first operation. In spite of delay in the diagnosis, he was relieved by operations (three times) and chemotherapy including high doses of Sulfamethoxazole-Trimethoprim. He was eventually discharged. We stress the necessity of early diagnosis and the efficacy of Sulfamethoxazole-Trimethoprim for nocardial brain abscess.

Topics: Adult; Anti-Bacterial Agents; Brain Abscess; Combined Modality Therapy; Drug Combinations; Humans; Male; Nocardia asteroides; Nocardia Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Kidney transplant recipients are at a high risk of both stroke and infection. We report this case to inform readers of the possibility of the occurrence of Listeria monocytogenes brain abscess despite treatment with low dose trimethoprim-sulfamethoxazole.. Physicians should monitor unusual stroke symptoms and consider Listeria brain abscess as a differential diagnosis. This case suggests that listeria brain abscesses can potentially cause temporary neurological deficits akin to a stroke, despite trimethoprim-sulfamethoxazole prophylaxis, but these symptoms resolve without necessitating surgical intervention.

Topics: Brain Abscess; Humans; Listeria monocytogenes; Listeriosis; Stroke; Trimethoprim, Sulfamethoxazole Drug Combination

Although there is a lack of data in trimethoprim-sulfamethoxazole (TMP-SMX) serum monitoring utility for invasive nocardial infections, therapeutic drug monitoring is widely used to optimize dosing and avoid adverse reactions that may cause treatment interruption.We retrospectively reviewed all adults who received TMP-SMX to treat nocardial brain abscess and had SMX serum level testing from 2010 to 2020.Twenty-two patients received treatment with TMP-SMX for Nocardia species brain abscess and 16 (72.7%) had a reported SMX level, with a median patient age of 65.5 years (interquartile range, IQR 59.5-72.5). Compared to those who did not have a documented SMX serum level, patients with SMX levels had a shorter median course of TMP-SMX treatment (322 days [IQR 188-365] vs. 365 [IQR 224-365]; P = .31) and higher therapeutic induction dose (10 [62.5%] vs. 3 [50%]; P = .92). Similarly, they were more frequently on hemodialysis (3 [13.6%] vs. 1 [4.5%]; P = > .99). The median peak level was 158.5 (IQR 120-218) μg/mL, collected at 2 hours (75%) post-administration in the induction phase (81.3%). Patients with documented SMX levels had fewer reported drug toxicity (5 [31.3%] vs. 4 [66.7%]; P = .1) than those without SMX levels. Among the five patients who reported TMP-SMX-related toxicity, 4 (80%) had an SMX peak level >150 μg/mL. There was no difference in the cure, relapse, and death rates among the two groups.While SMX level was not associated with Nocardia species brain abscess cure rates and mortality, most patients with SMX peak >150 μg/mL experienced drug toxicity.

Topics: Brain Abscess; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Male; Middle Aged; Nocardia; Retrospective Studies; Sulfamethoxazole; Trimethoprim, Sulfamethoxazole Drug Combination

Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant disease associated with neurological complications, including cerebral abscesses (CA). They tend to be unique, supratentorial and lobar. While the surgical intervention is a rule of thumb when treating and diagnosing the etiology of these lesions, this is not always possible due to dangerous or inaccessible locations. We report the case of a patient solely treated with empiric antibiotics without stereotaxic intervention and satisfactory results.. We present the case of a 21-year-old patient with a right thalamic abscess due to HHT and pulmonary arteriovenous malformations, previously embolized, treated solely with antibiotics. At first, we contemplated the possibility of a stereotaxic biopsy, but the high-risk location and the fact that our patient received a previous full course of antibiotic treatment (in another center), made us discard this intervention because of the low diagnostic yield. We started an empiric antibiotic regime. We followed up very closely the clinical and radiological evaluation the next weeks, adjusting our antibiotic treatment when necessary. The results were favorable from both the radiological and clinical aspects and 6 months after the diagnosis the images show its almost complete disappearance.. Carefully tailored antibiotic-only regime and vigilance of its adverse effects and close radiological following is a good treatment approach when surgery is not an option.

Topics: Anti-Bacterial Agents; Brain; Brain Abscess; Humans; Magnetic Resonance Imaging; Male; Pulmonary Veins; Telangiectasia, Hereditary Hemorrhagic; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Nocardiosis is an uncommon and potentially life-threatening infection that usually affects immunocompromised hosts. No clinical guidelines have been established for managing this rare disease, and the optimal treatment modality remains unclear. Nocardia farcinica, a relatively infrequent pathogen of nocardiosis, causes a clinically aggressive infection. In addition to our patient data, our search of the literature for patients who presented with empyema caused by N. farcinica will provide fundamental information for optimal treatment modalities.. A 64-year-old man was diagnosed with empyema, 4 days following surgery for sigmoid colon cancer. Brain lesions were evaluated only after N. farcinica was isolated and identified as the causative pathogen through repeated culture tests.. N. farcinica was isolated from the pleural effusion and confirmed as the pathogen through 16S rRNA sequencing.. The patient was successfully treated with tube thoracotomy, neurosurgical evacuation, and a combination of trimethoprim/sulfamethoxazole plus imipenem. Long-term antibiotic therapy was required to prevent recurrence.. Pyothorax showed a good clinical response to antimicrobial therapy and drainage of pleural effusion, whereas brain abscess did not respond to medical therapy and required surgery. The patient eventually recovered and continued chemotherapy as treatment for sigmoid colon cancer.. Although extremely rare, this report demonstrates the importance of considering Nocardia infection as the differential diagnosis in immunocompromised patients who present with empyema. In particular, because of the N. farcinica infection's tendency to spread and the resistance of the organism to antibiotics, aggressive evaluation of metastatic lesions and standardized support from microbiological laboratories are important. Surgery may be required in some patients with brain abscesses to improve the chance of survival.

Topics: Adenocarcinoma; Anti-Infective Agents; Brain Abscess; Colonic Neoplasms; Diagnosis, Differential; Empyema; Humans; Immunocompromised Host; Male; Middle Aged; Nocardia; Nocardia Infections; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

The infection by Nocardia spp is not common in immunocompetent patients. The empirical antimicrobial treatment directed by anatomical regions does not contemplate the particularities of the germ and the microbiological analysis is necessary for the specific treatment.\ We present the case of a previously healthy and immunocompetent patient, without known risk factors for Nocardia spp. infection, with evidence of involvement of the pulmonary parenchyma and the skin and subsequent development of multiple brain abscesses.. La infección por Nocardia spp. no es común en pacientes inmunocompetentes. El tratamiento antimicrobiano empírico dirigido según las regiones anatómicas, no contempla las particularidades del germen y el análisis microbiológico se hace necesario para el tratamiento específico. A continuación, se presenta el caso de una paciente previamente sana, inmunocompetente y sin factores de riesgo conocidos para la infección por Nocardia spp., con evidencia de compromiso en el parénquima pulmonar y la piel, que posteriormente desarrolló varios abscesos cerebrales.

Topics: Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Drug Therapy, Combination; Female; Headache; Humans; Immunocompetence; Magnetic Resonance Imaging; Middle Aged; Neuroimaging; Nocardia Infections; Pneumonia, Bacterial; Pulmonary Atelectasis; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

The management of patients with brain abscess poses a significant challenge to clinicians in patients with chronic kidney disease. Obtaining a biopsy sample from the affected area is the mainstay in the diagnosis, but it is often unavailable. In most cases, therapy is guided by clinical findings and imaging alone. We discuss three cases of brain abscess- each with a different scenario and discuss the issues faced in management. The first case was a 32-year-old post-renal transplant male patient with a brain abscess due to dematiaceous fungi and was treated with amphotericin. The second case was a 42-year-old female patient with stage 5 chronic kidney disease on maintenance hemodialysis who presented with a brain abscess due to suspected fungal infection based on imaging findings and was managed with antibiotics and voriconazole. The third case was a 42-year-old post-renal transplant male patient who presented with a brain abscess due to nocardiosis and was managed with cotrimoxazole, meropenem and linezolid. We also summarize the approach to the management of brain abscess in resource-limited settings.

Topics: Adult; Anti-Bacterial Agents; Antifungal Agents; Bacterial Infections; Brain Abscess; Female; Humans; Kidney Transplantation; Linezolid; Male; Meropenem; Mycoses; Renal Insufficiency, Chronic; Trimethoprim, Sulfamethoxazole Drug Combination; Voriconazole

Listeria monocytogenes (L. monocytogenes) is a facultative intracellular bacterial pathogen which can invade different mammalian cells and reach to the central nervous system (CNS), leading to meningoencephalitis and brain abscesses. In the diagnosis of L. monocytogenes meningoencephalitis (LMM), the traditional test often reports negative owing to the antibiotic treatment or a low number of bacteria in the cerebrospinal fluid. To date, timely diagnosis and accurate treatment remains a challenge for patients with listeria infections.. We present the case of a 66-year-old woman whose clinical manifestations were suspected as tuberculous meningoencephalitis, but the case was finally properly diagnosed as LMM by next-generation sequencing (NGS). The patient was successfully treated using a combined antibacterial therapy, comprising ampicillin and trimethoprim-sulfamethoxazole.. To improve the sensitivity of LMM diagnosis, we used NGS for the detection of L. monocytogenes. Hence, the clinical utility of this approach can be very helpful since it provides quickly and trust results.

Topics: Aged; Ampicillin; Anti-Bacterial Agents; Brain Abscess; Diagnostic Errors; Female; High-Throughput Nucleotide Sequencing; Humans; Listeria monocytogenes; Meningitis, Listeria; Meningoencephalitis; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Meningeal

Nocardia species are not commonly referred as primary infectious entities but rather as opportunistic pathogens. Infectious cases of Nocardia spp. in immunocompetent individuals are rare.. An immunocompetent 58-year-old patient presented with recurrent headaches.. A brain abscess was found and surgically drained. Matrix-assisted laser desorption ionization-time-of-flight mass spectrometry and heat shock protein 65/16S-23S rRNA gene intergenic spacer genotyping from the sample revealed the etiological agent as Nocardia beijingensis.. Meropenem/amikacin/Trimethoprim-sulfamethoxazole were administered.. The infection persisted leading to the patient's death.. Here we present the first case of N. beijingensis infection of the central nervous system in an immunocompetent patient from Latin America. Further inquiry is needed to establish whether this species is more virulent than other Nocardia isolates.

Topics: Anti-Bacterial Agents; Brain Abscess; Humans; Latin America; Male; Meropenem; Middle Aged; Nocardia; Nocardia Infections; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Listeria monocytogenes is an intracellular organism which is well recognised for its ability to cause meningeal infections in neonates, immunosuppressed, debilitated and elderly individuals.

Topics: Anti-Bacterial Agents; Brain Abscess; DNA, Bacterial; Female; Humans; Immunocompromised Host; Infectious Encephalitis; Listeria monocytogenes; Listeriosis; Magnetic Resonance Imaging; Middle Aged; Polymerase Chain Reaction; Trimethoprim, Sulfamethoxazole Drug Combination

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

Melioidosis is an uncommon tropical infectious disease caused by Burkholderia pseudomallei. Neurological complications of melioidosis are extremely uncommon in infants. A 10-month-old girl is described who presented with disseminated melioidosis with subcutaneous nodules, arthritis, hepatomegaly and a lung cavity, and developed a left medial rectus palsy. Cranial MRI demonstrated mid-brain, pontine and basal ganglia micro-abscesses. Therapy with meropenem and cotrimoxazole led to resolution of the medial nerve palsy. At 5-month follow-up, the child had no residual neurological deficits.

Topics: Anti-Bacterial Agents; Brain; Brain Abscess; Brain Stem; Burkholderia pseudomallei; Female; Humans; Infant; Magnetic Resonance Imaging; Melioidosis; Meropenem; Thienamycins; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Brain nocardiosis is a serious opportunistic infection with high mortality. It exists more common in the immunocompromised hosts than the immunocompetent patients. Trimethoprim-sulfamethoxazole (TMP-SMZ) has been mostly considered as the choice of the medical treatment. Linezolid is also newly found to be effective to avoid the invasive surgery. The authors reported a case of patient with multifoci nocardial brain abscesses who failed with the combination of linezolid and TMP-SMZ alone but recovered with the surgery intervention and sequential antibiotics for 2 years. The patient lived a high quality life without recurrence and complications during the 30 months follow-up.Through the literature review, we recommend earlier stereotactic aspiration for diagnosis, combination with surgery intervention and prolonged anti-infection therapy would improve the prognosis.

Topics: Acetamides; Adult; Anti-Bacterial Agents; Brain Abscess; Cefoperazone; Drug Therapy, Combination; Humans; Immunocompromised Host; Linezolid; Male; Nocardia Infections; Opportunistic Infections; Oxazolidinones; Sulbactam; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardiosis of the central nervous system is a challenging and difficult diagnosis for the clinician. The combination of infections of the brain and spinal cord is even more rare. The authors report on a patient with multiple lesions in the brainstem and cervical spinal cord. This 81-year-old immunocompetent woman presented with symptoms of progressive walking difficulty and ataxia. The results of an extensive workup with laboratory investigation, MRI, lumbar puncture, positron emission tomography (PET), and bone marrow biopsy remained inconclusive. Only after an open biopsy of a cervical lesion by an anterior approach through a partial central corpectomy of the cervical spine, was the diagnosis of nocardiosis made, allowing for specific antibiotic treatment.

Topics: Anti-Infective Agents; Brain Abscess; Brain Diseases; Brain Stem; Central Nervous System Bacterial Infections; Cervical Vertebrae; Female; Humans; Magnetic Resonance Imaging; Nocardia; Nocardia Infections; Spinal Cord Diseases; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Aged, 80 and over; Amikacin; Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Drug Therapy, Combination; Eye Infections, Bacterial; Humans; Magnetic Resonance Imaging; Male; Microbial Sensitivity Tests; Native Hawaiian or Other Pacific Islander; Nocardia; Nocardia Infections; Retinal Diseases; Trimethoprim, Sulfamethoxazole Drug Combination; Vitrectomy

Nocardiosis is an acute or chronic infectious disease caused by the soil-borne filamentous bacteria belonging to the genus Nocardia. The organisms opportunistically infect both immunocompromised and immunocompetent individuals. The lungs are the primary site of infection and brain abscess is, by far, the most common complication following nocardial metastasis from pulmonary lesions. Although surgical intervention must always be considered in the treatment of nocardial brain abscess, it can obviously be cured by antibiotic therapy alone. This report describes a case infected by Nocardia cyriacigeorgica. Identification of the infectious agent was achieved by conventional and semi-nested PCR techniques. A 55-year-old woman with fever was referred to the infect disclinic of Imam Khomeini hospital in Tehran and was hospitalized after clinical assessment. She was a kidney transplant recipient for 4 years and was taking immunosuppressive treatment including azathioprine and methylprednisolone. Follow-up of the patient by CT scan revealed pulmonary infection and cerebral lesions. Specimens of the brain lesions contained filamentous bacteria. The patient received a combination of co-trimoxazole and ceftriaxone and brain abscesses as well as lung inflammation disappeared gradually during the course of antibiotic therapy within 3 months. The patient was discharged from the hospital after 2 months of therapy.

Topics: Anti-Infective Agents; Brain Abscess; DNA, Fungal; Female; Humans; Immunocompromised Host; Iran; Middle Aged; Nocardia; Nocardia Infections; Polymerase Chain Reaction; Radiography; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Trimethoprim, Sulfamethoxazole Drug Combination

We herein report on a 69-year-old male who developed lung nocardiosis and brain abscessation. In April 2011, he was diagnosed as having systemic lupus erythematosus complicated by peripheral neuropathy. Immunosuppressive therapy with high-dose prednisolone was begun. In November 2011, he developed cryptococcal pneumonia and meningitis, which was treated with liposomal amphotericin and flucytosine for 4 weeks and was maintained with fluconazole. In April 2012, consolidation and peripheral atelectasis in the right middle lobe appeared. Bronchoscopy revealed edematous mucosa in the right middle bronchus and occlusive change of the right B4 and B5, but biopsy and culture results provided no etiological information. In late June, he developed an intermittent fever, and obstructive pneumonia of the right middle lobe was suspected. Nocardia species were detected from the sputum culture and were thought to be the causative pathogen. Brain CT and MRI revealed a contrast-enhanced lesion in the right cerebellar hemisphere. The patient was diagnosed as having lung nocardiosis and brain abscessation. Considering that the nocardiosis had developed under prophylaxis for Pneumocystis jirovecii pneumonia using one tablet per day of a sulfamethoxazole-trimethoprim combination, meropenem and amikacin were administered in addition to the sulfamethoxazole-trimethoprim combination for 6 and 4 weeks, respectively. After N. elegans had been identified from the sputum, antibiotics were switched to a sulfamethoxazole-trimethoprim combination and clarithromycin based on the susceptibility results. The patient's clinical and radiological findings were improved and have been well sustained.

Topics: Aged; Brain Abscess; Clarithromycin; Humans; Lupus Erythematosus, Systemic; Male; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

A 60-year-old man on chronic corticosteroids developed diplopia, gait instability and facial weakness. Brain MRI revealed a multiloculated pontine lesion. Cerebrospinal fluid (CSF) analysis demonstrated a neutrophil-predominant pleocytosis with elevated protein and low glucose. CSF cultures were negative, as was an extensive infectious diseases evaluation. Neurosurgical intervention was deferred in favour of empiric antimicrobial therapy due to the lesion's inaccessible location. After discontinuation of therapy, the patient reported a severe headache. A subsequent MRI demonstrated intraventricular pus. CSF culture grew Nocardia farcinica. The patient received parenteral therapy followed by oral trimethoprim-sulfamethoxazole. At 9 months, he is symptom free. This case illustrates the importance of including Nocardia in the differential diagnosis of brainstem abscesses, especially in immunocompromised patients. The availability of antimicrobial agents with excellent Nocardia activity and CSF penetration may enable treatment of brainstem abscesses for which surgical intervention has traditionally been considered necessary with medical management alone.

Topics: Anti-Infective Agents; Brain Abscess; Diagnosis, Differential; Diagnostic Imaging; Humans; Male; Middle Aged; Nocardia; Nocardia Infections; Pons; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents; Brain Abscess; Everolimus; Fatal Outcome; Female; Humans; Immunosuppressive Agents; Insulinoma; Middle Aged; Neoplasm Metastasis; Nocardia; Nocardia Infections; Pancreatic Neoplasms; Sirolimus; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardiosis is a life-threatening infection that affects the lungs, skin, and central nervous system, particularly in immune-compromised patients. We report a case of disseminated nocardiosis with pneumonia, brain abscesses, meningitis, and thyroiditis, for an individual with recent steroid therapy. Recovery was uneventful with a 4-month course of sulfamethoxazole-trimethoprim.

Topics: Aged; Brain Abscess; Female; Humans; Meningitis; Nocardia; Nocardia Infections; Pneumonia; Thyroid Diseases; Thyroiditis; Trimethoprim, Sulfamethoxazole Drug Combination

Localized and multisystem nocardiosis is an opportunistic disease that occurs commonly in immunocompromised patients. Rarely, it is also seen in immunocompetent individuals. The most common disease sites include lung, skin and central nervous system. We report a case of 73 years old man who is a known case of rheumatoid arthritis for more than 15 years and was on Methotrexate and Prednisolone. Now presented with generalized tonic clonic seizures. His Magnetic Resonace Imaging (MRI) scan showed a ring enhancing lesion with mild surrounding oedema in right posterior parietal cortex. Based on the finding, the most probable diagnosis of cerebral abscess was suggested. Patient underwent right sided craniotomy with aspiration of abscess. Serum Gram staining showed branching Gram-positive rods, and serum culture showed colonies of Nocardia Asteroides. He was started on Sulfamethoxazole-Trimethoprim. On follow-up examination, the patient showed marked improvement clinically and was discharged in stable condition on long term antibiotic therapy. This case highlights the importance of including nocardia on the differential diagnosis especially in patients who present with abnormal MRI scan findings that mimic tuberculoma or neoplastic disease. Clinical awareness of this condition could expedite the diagnostic process and help improve morbidity and mortality.

Topics: Aged; Anti-Infective Agents; Brain Abscess; Craniotomy; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Male; Nocardia asteroides; Nocardia Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of epididymo-orchitis and central nervous system nocardiosis in a 22-year-old man with T-cell acute lymphoblastic leukemia; he was an allogeneic marrow recipient with acute and chronic graft-versus-host disease.. He had microscopic hematuria and cytomegalovirus antigenemia. He deteriorated subsequently while on cyclosporine and steroids, requiring hospital admission owing to fever and swelling of the left testis and generalized tonic-clonic convulsions.. Brain magnetic resonance imaging showed abnormal signal area in right parietal and left parieto-occipital lobes. The lesions had mass effect, edema, and ring enhancement. Findings were indicative of a brain abscess. A testicular biopsy from the lower pole of the left testis was done. A white-to-yellowish discharge was seen and subsequently, Nocardia grew in culture.. Trimethoprim-sulfamethoxazole was prescribed, and significant improvement was seen after 2 weeks. The patient was discharged. He was subsequently referred after 3 weeks due to graft-versus-host disease and died of pancytopenia.

Topics: Acute Disease; Anti-Infective Agents; Bone Marrow Transplantation; Brain Abscess; Chronic Disease; Epididymitis; Epilepsy, Tonic-Clonic; Fatal Outcome; Graft vs Host Disease; Humans; Immunosuppressive Agents; Magnetic Resonance Imaging; Male; Nocardia Infections; Orchitis; Pancytopenia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

We report a 62-year-old woman presenting with nocardia brain abscess that mimics metastatic brain tumor. Six months before admission to our hospital, she presented with persistent hemoptysis, and a friable endobronchial mass was detected at another hospital. However, a definite diagnosis had not been made, and then she presented with hemianopia. Her laboratory analysis results showed that she had no immunological abnormalities. T1-weighted magnetic resonance images of the brain with Gd-DTPA revealed hyperintensive multiple masses with surrounding edema. We suspected this case as metastatic brain tumor of unknown origin, and the patient underwent biopsy of the supraclavicular lymph node. Histopathology results indicated abscess, and gram staining of material obtained from the abscess showed Gram-variable rods, which were determined upon culture as acid-fast Gram-positive branching rods and identified as Nocardia asteroides. Accordingly, we diagnosed the patient as having nocardia brain abscess, and she was treated with an oral antibiotic (TMP-SMX). Four months later, the abscesses disappeared. The patient recovered after prolonged TMP-SMX therapy with no recurrence in over 9 months.

Topics: Administration, Oral; Anti-Infective Agents; Brain Abscess; Brain Neoplasms; Diagnosis, Differential; Female; Humans; Middle Aged; Nocardia asteroides; Nocardia Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardiosis has become a significant opportunistic infection over the last two decades as the number of immunocompromised individuals has grown worldwide. We present two patients with nocardial brain abscess. The first patient was a 39-year-old woman with systemic lupus erythematosus. A left temporoparietal abscess was detected and aspirated through a burr-hole. Nocardia farcinica infection was diagnosed. The patient had an accompanying pulmonary infection and was thus treated with imipenem and amikacine for 3 weeks. She received oral minocycline for 1 year. The second patient was a 43-year-old man who was being treated with corticosteroids for glomerulonephritis. He was diagnosed with a ring-enhancing multiloculated abscess in the left cerebellar hemisphere, with an additional two small supratentorial lesions and triventricular hydrocephalus. Gross total excision of the cerebellar abscess was performed via a left suboccipital craniectomy. Culture revealed Nocardia asteroides, and the patient was successfully treated with intravenous ceftriaxone, then oral trimethoprime-sulfamethoxazole for 1 year. The clinical course, radiological findings, and management of nocardial brain abscess are discussed in light of the relevant literature, and current clinical management is reviewed through examination of the cases presented here.

Topics: Adult; Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Female; Humans; Lupus Erythematosus, Systemic; Magnetic Resonance Imaging; Male; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

A 71-year-old woman presented with suspected tuberculosis. She reported having productive coughs, unwanted weight loss and subfebrile temperature in the preceding 3 months. She was known to have chronic obstructive pulmonary disease treated with corticoids given systemically and by inhalation. She was a heavy smoker.. Computed tomography revealed a left apical lung abscess. In the further course of the disease magnetic resonance imaging of the head demonstrated multiple abscesses in both cerebral hemispheres and an abscess, 3.4 cm in diameter, in the right side of the cerebellum, as well as a intra-orbital tumor on the right. Needle aspirate of the eyeball grew Nocardia farcinica.. Over 3 weeks antimicrobial treatment was given with imipenem and amikacin, followed by oral cotrimoxazole for 12 months. The abscesses completely regressed and after 12 months no recurrence was demonstrated either radiologically or clinically.. Although nocardiasis is rare in Germany it must be included in the differential diagnosis of pneumonia with abscesses. This is especially so if acid-fast bacilli are found. As the resistance pattern of N. farcinica to antibiotics varies, early treatment is essential with antibiotics to which it is sensitive.

Topics: Aged; Amikacin; Anti-Bacterial Agents; Biopsy, Needle; Brain Abscess; Cerebellar Diseases; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Imipenem; Lung Abscess; Magnetic Resonance Imaging; Nocardia Infections; Orbital Diseases; Pneumonia, Bacterial; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Histopathology and special stains of a brain biopsy specimen from a 42-year-old man revealed numerous gram-positive bacilli arranged in branching filaments, suggesting Nocardia infection. Antibiotic therapy with trimethoprim-sulfamethoxazole markedly decreased the abscess size, and the patient improved. DNA was analyzed from formalin-fixed sections of the cerebral abscess by a 16S ribosomal DNA polymerase chain reaction assay demonstrating the presence of either Nocardia farcinica or N otitidiscaviarum. A species-specific polymerase chain reaction assay confirmed N farcinica as the etiologic agent.

Topics: Adult; Biopsy; Brain; Brain Abscess; DNA, Bacterial; DNA, Ribosomal; Humans; Magnetic Resonance Imaging; Male; Nocardia; Nocardia Infections; Polymerase Chain Reaction; RNA, Ribosomal, 16S; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Patients with End-stage Renal Disease being immunocompromised; are prone to a variety of infections, sometimes, rare ones, more than the general population. This fact should alert the physicians to be more vigilant and have a broader scope when considering the etiology of infections in such patients. We report the case of a 65-year-old man who had a very stormy hospital stay secondary to cerebral nocardiosis with multiple brain abscesses, prolonged unconsciousness and neurological deficits. However, the patient was treated successfully, surgically and chemotherapeutically. He was discharged home in a good condition.

Topics: Aged; Amikacin; Brain Abscess; Brain Diseases; Brain Edema; Ceftriaxone; Humans; Kidney Failure, Chronic; Male; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Unconsciousness; Vancomycin

Brain abscess with bacteremia caused by Listeria monocytogenes in a young woman with immune thrombocytopenic purpura was reported. The clinical features included fever, headache, and left-side weakness. Computed tomography and magnetic resonance imaging of the brain showed a large single abscess at the right frontoparietal area. L. monocytogenes was isolated from a blood culture. The patient promptly received a surgical drainage. Because she had a history of penicillin allergy, and the organism was resistant to ampicillin, she was treated with trimethoprim-sulfamethoxazole (TMP-SMX) alone for 12 months. During a one-year follow-up period, the patient improved and her neurological deficit gradually recovered. This is the first case of listerial brain abscess in Thailand that was successfully treated with TMP-SMX monotherapy and surgical drainage.

Topics: Adult; Anti-Bacterial Agents; Brain Abscess; Female; Humans; Listeria monocytogenes; Listeriosis; Magnetic Resonance Imaging; Thailand; Trimethoprim, Sulfamethoxazole Drug Combination

Infection with Nocardia asteroides is a rare, life-threatening infection, which is most commonly encountered in immunocompromised patients. Cutaneous involvement is usually seen with disseminated infection but may also occur as primary cutaneous nocardiosis. We present a case of an immunocompromised patient who presented with cellulitis of the right hand and disseminated subcutaneous nodules of the lower extremities resembling erythema nodosum. Cultures from both a skin biopsy of a subcutaneous nodule on the leg as well as a surgical specimen from the debridement of her hand grew Nocardia asteroides. The patient was treated successfully with trimethoprim-sulfamethoxazole. This case likely represents primary cutaneous nocardiosis with secondary dissemination, which has been rarely reported. It also emphasizes that nocardial infection should be considered in the differential diagnosis of lesions suggestive of cellulitis or erythema nodosum in the severely immunocompromised patient.

Topics: Anti-Infective Agents; Brain Abscess; Female; Humans; Immunocompromised Host; Kidney Transplantation; Middle Aged; Nocardia asteroides; Nocardia Infections; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acetamides; Ampicillin; Anti-Bacterial Agents; Brain Abscess; Drug Hypersensitivity; Drug Therapy, Combination; Humans; Linezolid; Listeriosis; Male; Middle Aged; Oxazolidinones; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Amikacin; Anti-Bacterial Agents; Brain Abscess; Diabetes Mellitus, Type 2; Drug Therapy, Combination; Humans; Imipenem; Lung Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Nocardia Infections; Shoulder; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardiosis is an uncommon pediatric infection. We describe the successful treatment of Nocardia brain abscesses and meningitis in an immunocompromized boy with a history of both liver and bone marrow transplants.

Topics: Anti-Bacterial Agents; Bone Marrow Transplantation; Brain Abscess; Child; Drug Therapy, Combination; Humans; Immunocompromised Host; Liver Transplantation; Male; Meningitis, Bacterial; Nocardia asteroides; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardia farcinica has been reported as an increasingly frequent cause of localized and disseminated infections in immunocompromised patients in recent years, but N. farcinica bacteraemia remains a rare finding. Here, the case is described of a 68-year-old man with end-stage renal disease and idiopathic thrombocytopenia purpura treated with steroid therapy who developed disseminated infection (bacteraemia, multilobar pneumonia and brain abscesses) due to N. farcinica. The isolate was confirmed by partial sequencing analysis of the 16S rRNA gene. The patient recovered after prolonged trimethoprim-sulfamethoxazole therapy with no recurrence in over 1 year.

Topics: Aged; Bacteremia; Brain Abscess; DNA, Bacterial; DNA, Ribosomal; Humans; Male; Nocardia; Nocardia Infections; Pneumonia; Purpura, Thrombocytopenic, Idiopathic; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Steroids; Trimethoprim, Sulfamethoxazole Drug Combination; Uremia

Topics: Adult; Anorexia; Anti-Bacterial Agents; Brain Abscess; Combined Modality Therapy; Diagnosis, Differential; Female; Fever; Headache; Humans; Immunocompromised Host; Liver Abscess; Lupus Erythematosus, Systemic; Nocardia asteroides; Nocardia Infections; Opportunistic Infections; Pleural Effusion; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardial infections in an immunocompromised host have been increasingly reported. Nocardial brain abscess, the most common presentation of nocardiosis in the central nervous system, is associated with a high mortality rate because of its delayed diagnosis and its unresponsiveness to the usual antibiotic therapy. We report four patients who experienced a long-term cure of nocardial brain abscess due to treatment by a combination of surgery and postoperative antibiotic therapy; 1 man and 3 women, ages ranging from 43 to 67 years old. Two patients were associated with systemic lupus erythematosus and two with autoimmune hemolytic anemia. Patients underwent surgical aspiration and drainage of brain abscess. Nocardia was identified from the aspirated specimen and postoperative antibiotic therapy for 5-6 weeks was performed using effective antibiotic agents; sulfamethoxazole/trimethoprim (ST), imipenem/cilastatin and minocycline (MINO) in Case 1, ST and MINO in Case 2, erythromycin in Case 3, and panipenem/betamipron and cefotaxime in Case 4. Case 3 and Case 4 with multilobulated brain abscess underwent total excision of the brain abscess. All patients showed successful cure of nocardial brain abscess with no recurrence for the period of 1-8 years. The combination of surgery and postoperative antibiotic therapy provides a good prognosis for nocardial brain abscess.

Topics: Adult; Aged; Anemia, Hemolytic, Autoimmune; Anti-Bacterial Agents; beta-Alanine; Brain Abscess; Cefotaxime; Cilastatin; Cilastatin, Imipenem Drug Combination; Drainage; Drug Combinations; Drug Therapy, Combination; Female; Humans; Imipenem; Immunocompromised Host; Lupus Erythematosus, Systemic; Male; Middle Aged; Minocycline; Nocardia Infections; Postoperative Care; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardia asteroides cerebral abscesses are rare but challenging intracranial lesions. Early diagnosis, institution of appropriate antimicrobial therapy, lack of underlying systemic disease and limited intracranial disease are recognized factors leading to good outcome. However, the optimal treatment approach has not been established and nocardial brain abscesses have been managed either conservatively, with steroetactic aspirations or with open craniotomy and enucleation. We present three cases of Nocardia asteroides cerebral abscesses cured only after neurosurgical enucleation, and discuss the current management alternatives and conclude that a more aggressive approach than that currently preferred for this entity may be more effective.

Topics: Adult; Aged; Amikacin; Anti-Bacterial Agents; Brain Abscess; Brain Neoplasms; Cefotaxime; Diagnosis, Differential; Drug Therapy, Combination; Humans; Imipenem; Magnetic Resonance Imaging; Male; Nocardia asteroides; Nocardia Infections; Sulfadiazine; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Diagnostic laboratories increasingly offer bacterial identification to the species level. The 17 nocardia species known to date differ in their clinical presentation, antibiotic resistance patterns and geographic distribution. The discovery of a new species with pathogenicity for humans calls for the characterization of its clinical and epidemiological properties.. Nocardia isolated from multifocal brain abscesses of an immunocompromised patient were further identified by the analysis of their cellular fatty acids and sequencing of the 16S ribosomal DNA. Quantitative antibiotic resistance testing was performed with E-tests.. The 16S ribosomal DNA analysis showed a 99 % homology to Nocardia cyriacigeorgici. This is the first report of this species as an invasive human pathogen. N. cyriacigeorgici was found susceptible for meropenem, amikacin, ceftriaxon and cotrimoxazole. The combination of surgical drainage and antibiotic treatment for 13 months was curative.. N. cyriacigeorgici has the potential to cause invasive infections at least in immunocompromised patients. Comparing clinical and in vitro characteristics with N. asteroides, the main causative agent of nocardial infections in Europe, we found no clinically relevant differences.

Topics: Amikacin; Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; DNA, Ribosomal; Drainage; Humans; Immunocompromised Host; Male; Meropenem; Microbial Sensitivity Tests; Middle Aged; Nocardia; Nocardia Infections; RNA, Ribosomal, 16S; Sequence Homology, Nucleic Acid; Thienamycins; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Opportunist central nervous system infections occur in about 5% to 10% of all renal transplant recipients, but reports of brain abscesses are very rare (1). Nocardia asteroides cerebral abscesses are scarce intracranial lesions. They account for only 2% of brain abscesses (2). Published data about these lesions have taken the form of short reports, small cases series and reviews. A universally accepted and effective treatment approach has not yet been established. We present a renal transplant patient with a cerebral abscess caused by Nocardia asteroides.

Topics: Adult; Anti-Bacterial Agents; Brain Abscess; Humans; Immunocompromised Host; Kidney Transplantation; Magnetic Resonance Imaging; Male; Nocardia asteroides; Nocardia Infections; Opportunistic Infections; Postoperative Complications; Trimethoprim, Sulfamethoxazole Drug Combination

The involvement of the central nervous system in paracoccidioidomycosis is more frequent than previously thought. The first reference to the possibility that Paracoccidioides brasiliensis could affect the central nervous system was by Pereira & Jacobs in 1919. Since then, a great number of other studies has showed this form of clinical behavior and, in some of them, the frequency has ranged 27.27%. We report a clinical case of a 34-year-old white Brazilian woman admitted because of bacterial pneumonia. In the sixth day of admission, the patient developed cerebellar symptomatology with nausea, vomiting, dysmetria and gait disturbance. Central nervous system computer tomographic scanning disclosed a hypodense lesion in the right cerebellar hemisphere. The patient was submitted to surgery with total excision of the lesion. Histopathological examination confirmed the diagnosis of neuroparacoccidioidomycosis. Coadjuvant treatment with sulfamethoxazole-trimetoprim was introduced. The patient had a good outcome and was discharge 30 days after surgery.

Topics: Adult; Antifungal Agents; Brain Abscess; Chronic Disease; Female; Humans; Paracoccidioidomycosis; Trimethoprim, Sulfamethoxazole Drug Combination

A patient with AIDS, treated with highly active antiretroviral therapy and trimethoprim-sulfamethoxazole, presented with confusion, a hemifield defect, and a mass lesion in the right occipital lobe. A brain biopsy confirmed granulomatous amebic encephalitis (GAE) due to Acanthamoeba castellanii. The patient was treated with fluconazole and sulfadiazine, and the lesion was surgically excised. This is the first case of AIDS-associated GAE responding favorably to therapy. The existence of a solitary brain lesion, absence of other sites of infection, and intense cellular response in spite of a very low CD4 count conditioned the favorable outcome. We review and discuss the diagnostic microbiologic options for the laboratory diagnosis of infections due to free-living amebae.

Topics: Acanthamoeba; Acquired Immunodeficiency Syndrome; Adult; Amebiasis; Animals; Antibiotic Prophylaxis; Antiretroviral Therapy, Highly Active; Biopsy; Brain; Brain Abscess; Didanosine; Fluconazole; Humans; Male; Saquinavir; Sulfadiazine; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Infective Agents; Anti-Inflammatory Agents; Brain Abscess; Humans; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Meropenem; Neutrophils; Nocardia Infections; Sarcoidosis, Pulmonary; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination

Infection with Nocardia spp. is an uncommon but important cause of morbidity and mortality in organ transplant recipients. Cotrimoxazole prophylaxis against urinary tract infection and Pneumocystis carinii pneumonia in these patients usually prevents nocardial infection also. We report the case of a patient on tacrolimus and mycophenolate mofetil who developed drug-induced diabetes mellitus followed by nocardial brain infection. This infection occurred despite conventional cotrimoxazole prophylaxis. Physicians should be aware that newer, more potent and more diabetogenic immunosuppressive regimens may increase the risk of opportunistic infections such as nocardiosis, even in the presence of "adequate" antimicrobial preventive measures.

Topics: Adult; Anti-Bacterial Agents; Brain Abscess; Diabetes Mellitus; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Mycophenolic Acid; Nocardia asteroides; Nocardia Infections; Opportunistic Infections; Tacrolimus; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents; Brain Abscess; Graft Rejection; Humans; Kidney Transplantation; Male; Middle Aged; Nocardia Infections; Pneumonia, Bacterial; Skin Diseases; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardia is a serious opportunistic infection in renal transplant recipients and nocardial brain abscess in these patients has a high mortality. In addition to antimicrobial therapy, treatment usually involves craniotomy and excision of the abscess. We describe a renal transplant recipient maintained on cyclosporine and prednisone developing Nocardia Asteroides brain abscess. After stereotactic aspiration of the abscess, successful treatment was achieved by triple therapy with trimethoprim sulfamethoxazole (TMP/SMX), ceftriaxone and amikacin. The allograft function remained stable. Long-term prophylaxis with TMP/SMX is necessary to prevent the relapse of nocardia.

Topics: Amikacin; Brain Abscess; Ceftriaxone; Drug Therapy, Combination; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Opportunistic Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Aged; Anti-Bacterial Agents; Brain Abscess; Focal Infection; Humans; Immunocompetence; Male; Minocycline; Nocardia asteroides; Nocardia Infections; Seizures; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

Systemic infections with Nocardia species continue to be a serious threat to immunosuppressed hosts. Diagnosis of these infections can be difficult despite their known tendency for cerebral and subcutaneous involvement. We describe a patient who presented with nonspecific constitutional symptoms and was found to have subcutaneous and cerebral abscesses due to Nocardia farcinica. In addition, a blood culture yielded the organism. The patient responded remarkably to oral therapy; resolution of the cerebral disease was observed on serial magnetic resonance images. We discuss the important clinical features on N. farcinica infection, the rarity of positive blood cultures, and the importance of susceptibility testing of Nocardia species in selecting drug therapy.

Topics: Anti-Bacterial Agents; Brain Abscess; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Nocardia; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

In France, where 70% of adults are latently infected by toxoplasma, from 20% to 40% of patients with AIDS developed toxoplasmic encephalitis until recently. The prophylactic use of drugs which are active against pneumocystis and toxoplasma has proven to be efficient. These drugs are trimethoprim-sulfamethoxazole or dapsone-pyrimethamine. With the extent of these primary prophylaxis, there is a decrease of risk of toxoplasma encephalitis; thus the rate of toxoplasma encephalitis among opportunistic infections has fallen off from 19% of the patients in 1988 to 6% in 1994, in the department of infectious diseases of the Pitié-Salpêtrière hospital. However, toxoplasmic abscesses occurring despite the prophylaxis are frequently slow growing lesions which can become huge with a moderate mass effect, mimicking the pattern of primary cerebral lymphoma. The rule of antitoxoplasmic trial treatment must be strictly followed, even under prophylaxis.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Antiprotozoal Agents; Brain Abscess; Brain Neoplasms; Chemoprevention; Dapsone; Diagnosis, Differential; Drug Combinations; Encephalitis; France; Humans; Lymphoma, AIDS-Related; Pyrimethamine; Toxoplasmosis, Cerebral; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Anti-Bacterial Agents; Anus Diseases; Brain Abscess; Diabetes Mellitus, Type 2; Drug Therapy, Combination; Hemiplegia; Humans; Immunocompetence; Listeriosis; Male; Middle Aged; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Bacteremia; Brain Abscess; Humans; Male; Nocardia; Nocardia Infections; Pneumonia, Bacterial; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Ampicillin; Brain Abscess; Female; Humans; Immunosuppression Therapy; Kidney Transplantation; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Antineoplastic Agents; Brain Abscess; Cefotaxime; Drug Therapy, Combination; Gentamicins; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Listeriosis; Male; Prednisone; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Vidarabine

We have reported a case of sulfonamide-induced acute pancreatitis. A review of the literature showed only eight previously reported cases. Adverse reactions to sulfonamides are well known, but acute pancreatitis is a very serious complication. If evidence of pancreatic involvement occurs during sulfonamide therapy, the medication should be discontinued immediately and, if necessary, be replaced by an alternative. Other causes of pancreatitis must be excluded.

Topics: Acute Disease; Alanine Transaminase; Alkaline Phosphatase; Aspartate Aminotransferases; Brain Abscess; Endoscopy, Digestive System; Humans; Male; Middle Aged; Nocardia Infections; Pancreatitis; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

A patient is described in whom there developed a pulmonary infiltrate and constrictive pericarditis caused by a combined Actinomyces and Actinobacillus actinomycetemcomitans infection, presumably originating from his poor dentition. The diagnosis was only made following repeated thoracotomy. After surgery, long-term treatment with antibiotics led to complete clinical recovery. None the less, some months later he was found to have a brain abscess which resolved during a further course of antibiotics. The variable clinical picture of actinomycosis is discussed, as well as the role of other bacteria frequently associated with actinomycotic infection, in particular Actinobacillus actinomycetemcomitans. The therapeutic implications are described.

Topics: Actinobacillus Infections; Actinomyces; Actinomycosis; Adult; Aggregatibacter actinomycetemcomitans; Brain Abscess; Humans; Male; Pericarditis, Constrictive; Pneumonia; Trimethoprim, Sulfamethoxazole Drug Combination

To report a case of Nocardia asteroides pneumonia and subsequent brain abscess in an immunocompromised host.. Private, community, teaching hospital.. A man readmitted to the hospital for a third time with a fatal brain abscess, after responding to (misdirected) therapy in previous admissions.. Treatment with cefuroxime, erythromycin, trimethoprim/sulfamethoxazole at different times.. Patient's condition deteriorated and he died after one month of intravenous trimethoprim/sulfamethoxazole therapy.. Because it is an infection of the immunocompromised host, it may be considered an AIDS-defining illness. Several other similar cases have been reported in the literature.

Topics: Acquired Immunodeficiency Syndrome; Adult; Brain Abscess; Humans; Immunocompromised Host; Male; Nocardia asteroides; Nocardia Infections; Pneumonia; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of multiple cerebral and spinal abscesses due to Nocardia asteroides in a non-immunocompromised patient. The initial central nervous system manifestation was a sterile meningitis, with secondary development of multiple cerebral and spinal abscesses. Since the location of the abscesses did not allow neurosurgical exploration and the cultures remained negative, the diagnosis was finally established by raised antibody titres to Nocardia asteroides. After specific antibiotic therapy, resolution of the spinal and cerebral abscesses was documented on the basis of serial magnetic resonance tomography and computed tomography controls.

Topics: Abscess; Amikacin; Brain Abscess; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neurologic Examination; Nocardia asteroides; Nocardia Infections; Spinal Cord Diseases; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Three groups of patients with single hemispheric brain abscesses or subdural empyemas, from 1 to 5 cm large, with similar initial prognosis, have been treated either by medical treatment alone (20), aspiration (21), or excision (15). Differences in survival were not found, but medical treatment alone was better for long term sequelae. Surgical procedures (either aspiration or excision) were better for both isolation of the organism and the hospital stay before discharge. In spite of good results, it is unwise to conclude too strongly in favour of no surgical treatment as this study was not randomised.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Brain Abscess; Cause of Death; Ceftriaxone; Combined Modality Therapy; Empyema, Subdural; Female; Humans; Male; Metronidazole; Pefloxacin; Postoperative Complications; Suction; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Adult; Amylases; Brain Abscess; Drug Combinations; Humans; Male; Nocardia asteroides; Nocardia Infections; Pancreatitis; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

After a scraping injury to the skin a 47-year-old man developed a generalized Nocardia brasiliensis infection with cutaneous, pulmonary and cerebral dissemination. There was no predisposing underlying illness. High-dosage cotrimoxazol and short-term intrathecal and systemic gentamycin administration achieved extensive healing. This form of treatment would thus seem capable of reversing the otherwise poor prognosis of generalized N. brasiliensis infection.

Topics: Brain Abscess; Dose-Response Relationship, Drug; Drug Combinations; Drug Therapy, Combination; Gentamicins; Humans; Injections, Spinal; Male; Middle Aged; Nocardia Infections; Skin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Infection

Topics: Amoxicillin; Ampicillin; Animals; Anti-Bacterial Agents; Blood-Brain Barrier; Brain Abscess; Cefuroxime; Cephacetrile; Chloramphenicol; Chromatography, High Pressure Liquid; Drug Combinations; Rabbits; Staphylococcal Infections; Sulfamethoxazole; Ticarcillin; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Brain Abscess; Drug Combinations; Humans; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination