Immunocompetent patient with Nocardia abscessus brain abscess: Case report and review of the literature

Abstract

Nocardia cerebral abscess is uncommon. It accounts for 1%-2% of all cerebral abscesses. It typically occurs in immunocompromised patients but cases in immunocompetent hosts been reported. Diagnosis of Nocardia brain abscess can be difficult and misleading. In this report we report a case of Nocardia abscessus brain abscess that was misdiagnosed initially as brain tumor. The patient has been successfully managed medically along with surgical evacuation twice.

Keywords

Nocardia / Nocardiosis / Nocardia abscessus / Brain abscess / Brain abscess in immunocompetent patient / Cerebral infection

AUTHORS’ CONTRIBUTION

The first two authors contributed equally to the paper.

CONFLICTS OF INTEREST DISCLOSURE

The authors declare they have no conflicts of interest.

References

[1] Mandell GL, Bennett JE, Dolin R, et al. Nocardia Species, in Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. Churchill Livingstone Elsevier; 2010. 3199 p. Available from: https://books.google.fr/books?id=SvRLA QAAIAAJ&q=Bennett\T1\textquoterights+Principles+a nd+Practice+of+Infectious+Diseases&dq=Bennett\T1\t extquoterights+Principles+and+Practice+of+Infectio us+Diseases&hl=fr&sa=X&ved=0ahUKEwjKzcnD0o_bAhUO6a QKHdEzCYUQ6AEIMDAB

[2] Lerner PI. Nocardiosis. Clin Infect Dis. 1996; 22(6): 891-903; quiz 904-5. PMid: 8783685. https://doi.org/10.1093/clinids/22.6.891

[3] Lederman ER, Crum NF. A case series and focused review of no-cardiosis: clinical and microbiologic aspects. Medicine (Baltimore). 2004; 83(5): 300-13. https://doi.org/10.1097/01.md.0000141100.30871.39

[4] Brownelliott BA, Brown JM, Conville PS, et al. Clinical and Lab-oratory Features of the Nocardia spp. Based on Current Molecu-lar Taxonomy. Clinical Microbiology Reviews. 2006; 19(2): 259-82. PMid: 16614249. https://doi.org/10.1128/CMR.19.2.259-282.2006

[5] Beaman BL, Beaman L. Nocardia species: host-parasite relationships. Clin Microbiol Rev. 1994; 7(2): 213-64. https://doi.org/10.1128/CMR.7.2.213

[6] Roth A, Andrees S, Kroppenstedt RM, et al. Phylogeny of the Genus Nocardia Based on Reassessed 16S rRNA Gene Sequences Reveals Underspeciation and Division of Strains Classified as Nocardia aster-oides into Three Established Species and Two Unnamed Taxons. Jour-nal of Clinical Microbiology. 2003; 41(2): 851-6. PMid: 12574299. https://doi.org/10.1128/JCM.41.2.851-856.2003

[7] Kumar VA, Augustine D, Panikar D, et al. Nocardia farcinica brain abscess: epidemiology, pathophysiology, and literature re-view. Surgical Infections. 2014; 15(5): 640-6. PMid: 25126828. https://doi.org/10.1089/sur.2012.205

[8] Kilincer C, Hamamcioglu MK, Simsek O, et al. Nocardial brain abscess: Review of Clinical Management. Journal of Clinical Neuro-science. 2006; 13(4): 481-485. PMid: 16678731. https://doi.or g/10.1016/j.jocn.2005.04.031https://doi.org/10.1016/j.jocn.2005.04.031

[9] Lin YJ, Yang KY, Ho JT, et al. Nocardial brain abscess. Journal of Clinical Neuroscience. 2010; 17(2): 250-253. PMid: 20005722. https://doi.org/10.1016/j.jocn.2009.01.032

[10] Alijani N, Mahmoudzadeh S, Hedayat YM, et al. Multiple brain abscesses due to nocardia in an immunocompetent patient. Archives of Iranian Medicine. 2013; 16(3): 192. PMid: 23432175.

[11] Anagnostou T, Arvanitis M, Kourkoumpetis TK, et al. Nocardiosis of the central nervous system: experience from a general hospital and review of 84 cases from the literature. Medicine. 2014; 93(1): 19-32. PMid: 24378740. https://doi.org/10.1097/MD.0000000000000012

[12] Fellows G, Kalsi P, Martin A. Nocardia farcinica brain abscess in a patient without immunocompromise. British Journal of Neurosurgery. 2007; 21(3): 301-303. PMid: 17612924. https://doi.org/10.1080/02688690701365770

[13] Pyatigorskaya N, Brugieres P, Hodel J, et al. What is your diagnosis?. Journal of Neuroradiology. 2010; 37(3): 192-195. PMid: 19783307. https://doi.org/10.1016/j.neurad.2009.07.007

[14] Goodfellow M, Williams S. Ecology of actinomycetes. Annual Re-views in Microbiology. 1983; 37(1): 189-216. PMid: 6357051. http s://doi.org/10.1146/annurev.mi.37.100183.001201

[15] Ambrosioni J, Lew D, Garbino J. Nocardiosis: updated clinical review and experience at a tertiary center. Infection. 2010; 38(2): 89-97. PMid: 20306281. https://doi.org/10.1007/s15010-009-9193-9

[16] Palmer DL, Harvey RL, Wheeler JK. Diagnostic and therapeutic con-siderations in Nocardia asteroides infection. Medicine (Baltimore). 1974; 53(5): 391-401. https://doi.org/10.1097/00005792-197409000-00005

[17] Wallis RS, Broder MS, Wong JY, et al. Granulomatous infectious diseases associated with tumor necrosis factor antagonists. Clin-ical Infectious Diseases. 2004; 38(9): 1261. PMid: 15127338. https://doi.org/10.1086/383317

[18] Abreu C, Rochapereira N, Sarmento A, et al. Nocardia infections among immunomodulated inflammatory bowel disease patients: A review. World Journal of Gastroenterology. 2015; 21(21): 6491-6498. PMid: 26074688. https://doi.org/10.3748/wjg.v21.i21.6491

[19] Brouwer MC, Tunkel AR, Mckhann GM, et al. Brain abscess. New England Journal of Medicine. 2014; 371(5): 447-456. PMid: 25075836. https://doi.org/10.1056/NEJMra1301635

[20] Yen PT, Chan ST, Huang TS. Brain abscess: with special reference to otolaryngologic sources of infection. Otolaryngol Head Neck Surg. 1995; 113(1): 15-22. https://doi.org/10.1016/S0194-5998(95)70139-7

[21] Kangsanarak J, Fooanant S, Ruckphaopunt K, et al. Extracranial and intracranial complications of suppurative otitis media. Report of 102 cases. Journal of Laryngology & Otology. 1993; 107(11): 999-1004. PMid: 8288994. https://doi.org/10.1017/S0022215100125095

[22] Giannoni CM, Stewart MG, Alford EL. Intracranial complications of sinusitis. Laryngoscope. 1997; 107(7): 863-7. PMid: 9217120. https://doi.org/10.1097/00005537-199707000-00005

[23] Giannoni C, Sulek M, Friedman EM. Intracranial complications of sinusitis: a pediatric series. Am J Rhinol. 1998; 12(3): 173-8. PMid: 9653474. https://doi.org/10.2500/105065898781390127

[24] Gallagher RM, Gross CW, Phillips CD. Suppurative intracranial com-plications of sinusitis. Laryngoscope. 1998; 108(11 Pt 1): 1635-42. PMid: 9818818. https://doi.org/10.1097/00005537-199811000-00009

[25] Bakshi R, Wright PD, Kinkel PR, et al. Cranial Magnetic Resonance Imaging Findings in Bacterial Endocarditis: The Neuroimaging Spectrum of Septic Brain Embolization Demonstrated in Twelve Pa-tients. Journal of Neuroimaging. 1999; 9(2): 78-84. PMid: 10208104. https://doi.org/10.1111/jon19999278

[26] Patel KS, Marks PV. Multiple brain abscesses secondary to bronchiec-tasis. A case of 34 discrete abscesses in one brain. Clin Neurol Neu-rosurg. 1989; 91(3): 265-7. https://doi.org/10.1016/0303-8467(89)90123-6

[27] Fischer EG, Shwachman H, Wepsic JG. Brain abscess and cystic fibrosis. J Pediatr. 1979; 95(3): 385-8. https://doi.org/10.1016/S0022-3476(79)80511-9

[28] Yang SY, Zhao CS. Review of 140 patients with brain abscess. Surg Neurol. 1993; 39(4): 290-6. https://doi.org/10.1016/0090-3019(93)90008-O

[29] Schliamser SE, Backman K, Norrby SR. Intracranial abscesses in adults: an analysis of 54 consecutive cases. Scand J Infect Dis. 1988; 20(1): 1-9. PMid: 3363298. https://doi.org/10.3109/00365548809117210

[30] Lakshmi V, Rao R, Dinakar I. Bacteriology of brain ab-scess-observations on 50 cases. Journal of Medical Microbiology. 1993; 38(3): 187-190. PMid: 7681113. https://doi.org/10.1099/00222615-38-3-187

[31] Brook I. Aerobic and anaerobic bacteriology of intracranial abscesses. Pediatr Neurol. 1992; 8(3): 210-4. https://doi.org/10.1016/0887-8994(92)90070-F

[32] Brouwer MC, Coutinho JM, van de Beek D. Clinical characteris-tics and outcome of brain abscess: systematic review and meta-analysis. Neurology. 2014; 82(9): 806-13. PMid: 24477107. https://doi.org/10.1212/WNL.0000000000000172

[33] Valdezate S, Garrido N, Carrasco G, et al. Epidemiology and suscep-tibility to antimicrobial agents of the main Nocardia species in Spain. Journal of Antimicrobial Chemotherapy. 2016; 72(3).

[34] Yassin AF, Rainey FA, Mendrock U, et al. Nocardia abscessus sp. nov. Int J Syst Evol Microbiol. 2000; 50(4): 1487-1493. PMid: 10939654. https://doi.org/10.1099/00207713-50-4-1487

[35] Brown-Elliott BA, Conville P, Wallace RJ. Current status of Nocardia taxonomy and recommended identification methods. Clinical Micro-biology Newsletter. 2015; 37(4): 25-32. https://doi.org/10.1016/j.clinmicnews.2015.01.007

[36] Portolá O, Guitart R, Gómez F, et al. Epidemiology and clinical manifestations of infection due to Nocardia species in Tarragona, 1997-2008: Nocardia cyriacigeorgica is an emerging pathogen. En-fermedades Infecciosas Y Microbiología Clínica. 2009; 27(10): 585-588. PMid: 19477044. https://doi.org/10.1016/j.eimc.2009.02.008

[37] Maraki S, Scoulica E, Nioti E, et al. Nocardial infection in Crete, Greece: review of fifteen cases from 2003 to 2007. Scandinavian Jour-nal of Infectious Diseases. 2009; 41(2): 122-127. PMid: 19101858. https://doi.org/10.1080/00365540802651905

[38] Liu WL, Lai CC, Ko WC, et al. Clinical and microbiological charac-teristics of infections caused by various Nocardia species in Taiwan: a multicenter study from 1998 to 2010. European Journal of Clinical Microbiology & Infectious Diseases. 2011; 30(11): 1341. PMid: 21461846. https://doi.org/10.1007/s10096-011-1227-9

[39] Wellinghausen N, Pietzcker T, Kern WV, et al. Expanded spectrum of Nocardia, species causing clinical nocardiosis detected by molecu-lar methods. International Journal of Medical Microbiology. 2002; 292(3): 277-282. PMid: 12398218. https://doi.org/10.1078/1438-4221-00208

[40] Lai CC, Tsai HY, Ruan SY, et al. Fatal pneumonia and empyema thoracis caused by imipenem-resistant Nocardia abscessus, in a can-cer patient. Journal of Microbiology Immunology & Infection. 2015; 48(6): 706-708. PMid: 23523047. https://doi.org/10.1016/j.jmii.2013.01.005

[41] Kageyama A, Yazawa K, Kudo T, et al. First isolates of Nocar-dia abscessus from humans and soil in Japan. Japanese Journal of Medical Mycology. 2004; 45(1): 17-21. PMid: 14765097. https://doi.org/10.3314/jjmm.45.17

[42] Horré R, Schumacher G, Marklein G, et al. Mycetoma due to Pseu-dallescheria boydii and co-isolation of Nocardia abscessus in a pa-tient injured in road accident. Medical Mycology. 2002; 40(5): 525-527.PMid: 12462533. https://doi.org/10.1080/mmy.40.5.525.527

[43] Diego C, Ambrosioni JC, Abel G, et al. Disseminated nocardiosis caused by Nocardia abscessus in an HIV-infected patient: first re-ported case. Aids. 2005; 19(12): 1330-1. PMid: 16052092. https://doi.org/10.1097/01.aids.0000180108.96135.25

[44] Atzori L, Pau M, Aste N. Multiple cutaneous abscesses revealing dis-seminated nocardiosis in a patient with chronic rheumatoid arthritis. Cutis. 2014; 94(6): E25-8. PMid: 25566581.

[45] Marchandin H, Eden A, Jean-Pierre H, et al. Molecular diagnosis of culture-negative cerebral nocardiosis due to Nocardia abscessus. Diagnostic Microbiology & Infectious Disease. 2006; 55(3): 237-240.PMid: 16626912. https://doi.org/10.1016/j.diagmicrobio.2006.01.023

[46] Farran Y, Antony S. Nocardia abscessus-related intracranial aneurysm of the internal carotid artery with associated brain abscess: A case report and review of the literature. J Infect Public Health. 2016; 9(3): 358-61. PMid: 26724261. https://doi.org/10.1016/j.jiph.2015.11.009

[47] Al Tawfiq JA, Mayman T, Memish ZA. Nocardia abscessus brain abscess in an immunocompetent host. J Infect Public Health. 2013; 6(3): 158-61. PMid: 23668458. https://doi.org/10.1016/j.jiph.2012.11.012

[48] Munoz J, Mirelis B, Aragón L M, et al. Clinical and microbiological features of nocardiosis 1997-2003. Journal of Medical Microbiology. 2007; 56(Pt 4): 545.