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Nocardial cerebral abscess cured with imipenem/amikacin and enucleation

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Abstract

A 72 year old female with cerebral abscess due to Nocardia farcinica is reported. Needle aspiration, antimicrobial therapy using a new combination of imipenem and amikacin, and, finally, surgical excision led to prompt and complete recovery. This is the oldest patient to survive cerebral nocardiosis reported in the literature. This infection, is usually regarded as opportunistic and is encountered with increasing frequency in immunocompromised conditions (organ transplantation, chemotherapy, underlying disabling disorder, acquired immunodeficiency syndrome, etc.). The literature is extensively reviewed for various aspects of this disease including prognostic factors, recent developments in antibiotic therapy (imipenem, amikacin, minocycline etc.) and the essential role of surgery in the treatment strategy.

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References

  1. Adair JC, AC Beck, RI Apfelbaum, JR Baringer: Nocardial cerebral abscess in the acquired immunodeficiency syndrome. Arch Neurol 44 (1987) 548–550

    PubMed  Google Scholar 

  2. Ajax ET: Acquired dyslexia: a comparative study of two cases. Arch Neurol 11 (1964) 66–72

    PubMed  Google Scholar 

  3. Apuzzo MLJ, PT Chandrosoma, D Cohen, Chi-Sching Zee, V Zelman: Computed imaging stereotaxy: Experience and perspective related to 500 procedures applied to brain masses. Neurosurgery 20 (1987) 930–937

    PubMed  Google Scholar 

  4. Bach MC, LD Sabath, M Findland: Susceptibility of Nocardia asteroides to 45 antimicrobial agents in vitro. Antimicrobial Agents Chemotherapy 3 (1973) 1–8

    Google Scholar 

  5. Beaman BL, J Burnside, B Edwards, WA Causey: Occurence of nocardial infections in the United States during a 24-month period (1972–1974). J Infect Dis 134 (1976) 286–289

    PubMed  Google Scholar 

  6. Benbow EP, DT Smith, KS Grimson: Sulfonamide therapy in actinomycosis. Amer Rev Tuberculosis 49 (1944) 395–407

    Google Scholar 

  7. Bertoldi RV, MR Sperling: Nocardia brain stem abscess: diagnosis and response to medical therapy. Bull Clin Neurosci 49 (1984) 99–104

    PubMed  Google Scholar 

  8. Black MC, AP Monaco, M Finland: Pulmonary nocardiosis. Therapy with minocycline and with erythromycine plus ampicillin. JAMA 224 (1973) 1378–1381

    PubMed  Google Scholar 

  9. Brine JAS: Human nocardiosis, a developing clinical picture. Med J Aust 1 (1965) 339

    Google Scholar 

  10. Byrne E, BP Brophy, LV Perrett: Nocardia cerebral abscess: new concepts in diagnosis, management, and prognosis. J Neurol Neurosurg Psychiatry 42 (1979) 1038–1045

    PubMed  Google Scholar 

  11. Causey WA, R Lee: Nocardiosis. In:PJ Vinken, GW Bruyn (eds): Handbook of Clinical Neurology, Vol. 35. North-Holland Publishing Company, Amsterdam—New York—Oxford 1978

    Google Scholar 

  12. Cupp CM, WM Edwards, EA Cleve: Nocardiosis of the central nervous system: Report of two fatal cases. Ann Intern Med 52 (1960) 223–229

    PubMed  Google Scholar 

  13. DeLouvois J: Antimicrobial therapy in the treatment of brain abscess. J Antimicrob Chemother 12 (1984) 205–207

    Google Scholar 

  14. Eppinger H: Über eine neue pathogene Cladothrix und eine durch sie hervorgerufene Pseudotuberculosis. Wien Klin Wschr 3 (1890) 321–323

    Google Scholar 

  15. Epstein S, M Holden, J Feldshuh, JM Singer: Unusual cause of spinal cord compression: Nocardiosis. NY State J Med 63 (1963) 3422–3427

    Google Scholar 

  16. Ertl G, KP Schaal, K Kochsiek: Nocardial endocarditis of an aortic valve prosthesis. Br Heart J 57 (1987) 384–386

    PubMed  Google Scholar 

  17. Fainstein V, M Leavens, R Moser: Brain and meningeal biopsy in patients with acquired immunodeficiency syndrome. Tex Med 82 (1986) 40–45

    PubMed  Google Scholar 

  18. Fetter BF, G Lintworth, WS Hendry: Mycoses of the central nervous system. Williams and Wilkins, Baltimore 1967

    Google Scholar 

  19. Finkemeyer H, T Tzonos, M Stanisic: Ein Nokardia-Granulom des Ganglion Gasseri. Zbl Neurochir 28 (1967) 137–146

    Google Scholar 

  20. Frazier AR, EC Rorenow, GD Roberts: Nocardiosis. A review of twenty-five cases occuring during twenty-four months. Mayo Clin Proc 50 (1975) 657–663

    PubMed  Google Scholar 

  21. Friedman AH, E Bullitt: Fungal infections. In:HR Wilkins, SS Rengachary (eds): Neurosurgery, Vol. 3. McGraw-Hill, New York 1985

    Google Scholar 

  22. Garfield J: Brain abscesses and focal suppurative infections. In:PJ Vinken, GW Bruyn (eds): Handbook of Clinical Neurology, Vol. 33. North-Holland Publishing Company, Amsterdam—New York—Oxford 1978

    Google Scholar 

  23. Goodfellow M, MP Lechevalier: Genus Nocardia Trevisan 1889. In:PHA Sneath, NS Mair, ME Sharpe, JG Holt (eds): Bergey's Manual of Systematic Bacteriology, Vol. 2. Williams and Wilkins, Baltimore—London 1986

    Google Scholar 

  24. Goodman JS, MG Koenig: Nocardia infections in general hospital. Ann NY Acad Sci 174 (1970) 552–567

    PubMed  Google Scholar 

  25. Hall WA, AJ Martinez, JS Dummer, LD Lunsford: Nocardial brain abscess: diagnostic and therapeutic use of stereotactic aspiration. Surg Neurol 28 (1987) 114–118

    PubMed  Google Scholar 

  26. Hoeprich PD, D Brandt, RH Parker: Nocardial brain abscess cured with cycloserine and sulfonamides. Am J Med Sci 255 (1968) 208–216

    PubMed  Google Scholar 

  27. Houang ET, IS Lovett, FD Thompson, AR Harrison, AM Joekes, M Goodfellow: Nocardia asteroides infection — a transmissible disease. J Hosp Infection 1 (1980) 31–40

    Google Scholar 

  28. Jacobson JR, RB Cloward: Actinomycosis of the central nervous system: a case of meningitis with recovery. JAMA 137 (1948) 769–771

    Google Scholar 

  29. Kepes JJ, A Schoolman: Post-traumatic abscess of the medulla oblongata containing Nocardia asteroides. J Neurosurg 22 (1965) 511–514

    PubMed  Google Scholar 

  30. King RB, WL Stoops, J Fitzgibbons, P Bunn: Nocardia asteroides meningitis: a case successfully treated with large doses of sulfadiazine and urea. J Neurosurg 24 (1966) 749–751

    PubMed  Google Scholar 

  31. Kirmani N, C Tuazon, J Ocuin: Extensive cerebral nocardiosis cured with antibiotic therapy alone. J Neurosurg 49 (1978) 924–928

    PubMed  Google Scholar 

  32. Kremer EP: Pulmonary and Cerebral Nocardial Abscess. Med J Aust 2 (1972) 538–540

    PubMed  Google Scholar 

  33. Krueger EG, L Norsa, M Kenney, PA Price: Nocardiosis of the central nervous system. J Neurosurg 11 (1954) 226–233

    PubMed  Google Scholar 

  34. Levy RM, DE Bredesen, ML Rosenblum: Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): Experience at the University of California at San Francisco and review of the literature. J Neurosurg 62 (1985) 475–495

    PubMed  Google Scholar 

  35. List CF, JR Williams, CB Beeman, CA Payne: Nocardiosis with multilocular cerebellar abscess. Report of a cured case. J Neurosurg 11 (1954) 394–398

    PubMed  Google Scholar 

  36. Maderazo EG, R Quintiliani: Treatment of nocardial infection with trimethoprim-sulfamethoxazole. Am J Med 57 (1974) 671–675

    PubMed  Google Scholar 

  37. Munslow RA: Actinomycotic (Nocardia asteroides) brain abscess with recovery: case report. J Neurosurg 11 (1954) 399–402

    PubMed  Google Scholar 

  38. Murray, JF, SM Finegold, S Froman, D Will: The changing spectrum of nocardiosis: a review and presentation of nine cases. Am Rev Respir Dis 83 (1961) 315–330

    PubMed  Google Scholar 

  39. Nadjmi M, U Piepgras, H Vogelsang: Kranielle Computertomographie. Thieme, Stuttgart—New York 1981

    Google Scholar 

  40. Nauta HJW, FL Contreras, RL Weiner, MJ Crofford: Brain stem abscess managed with computed tomography — guided stereotactic aspiration. Neurosurgery 20 (1987) 476–480

    PubMed  Google Scholar 

  41. Norden CW, FL Ruben, R Selker: Nonsurgical treatment of cerebral nocardiosis. Arch Neurol 40 (1983) 594–595

    PubMed  Google Scholar 

  42. Palmer DL, RL Harvey, JK Wheeler: Diagnostic and therapeutic considerations in Nocardia asteroides infection. Medicine (Baltimore) 53 (1974) 391–401

    Google Scholar 

  43. Pizzolato P, J Ziskind, H Derman, EE Buff: Nocardiosis of the brain. Report of three cases. Amer J Clin Path 36 (1961) 151–156

    Google Scholar 

  44. Poretz DM, MN Smith, CH Park: Intracranial suppuration secondary to trauma infection with nocardia asteroides. JAMA 232 (1975) 730–731

    PubMed  Google Scholar 

  45. Rankin J, M Javid: Nocardiosis of the Central Nervous System. Neurology 5 (1955) 815–820

    PubMed  Google Scholar 

  46. Rosenblum ML, H Rosegay: Resection of multiple nocardial brain abscesses: Diagnostic role of computerized tomography. Neurosurgery 4 (1979) 315–318

    PubMed  Google Scholar 

  47. Schaal KP: Laboratory diagnosis of actinomycete diseases. In:Goodfellow M, M Mordarski, ST Williams (eds): The biology of the actinomycetes. Academic Press, London 1984

    Google Scholar 

  48. Schaal KP, BL Beaman: Clinical significance of actinomycetes. In:M Goodfellow, M Mordarski, ST Williams (eds): The biology of the actinomycetes. Academic Press, London 1984

    Google Scholar 

  49. Schaal KP, H Heimerzheim: Mikrobiologische Diagnose und Therapie der Lungennocardiose. Mykosen 17 (1974) 313–319

    PubMed  Google Scholar 

  50. Schaal KP, W Leischik: Zur Antibiotikatherapie der Nocardiose. Dtsch Med Wochenschr 94 (1969) 2505–2507

    PubMed  Google Scholar 

  51. Schaal KP, H Schütt-Gerowitt, A Goldmann: In vitro and in vivo studies on the efficacy of various antimicrobial agents in the treatment of human nocardiosis. In:G Szabó, S Biró, M Goodfellow (eds): Sixth Int Symp on Actinomycetes Biology 1984

  52. Schiefer, W, W Huk: Computerized tomographic findings with brain abscess. In:W Lanksch, E Kazner (eds): Cranial computerized axial tomography. Springer, Berlin 1976

    Google Scholar 

  53. Sharer LR, R Kapila: Neuropathologic observations in the acquired immunodeficiency syndrome. Acta Neuropathol 66 (1985) 188–198

    PubMed  Google Scholar 

  54. Shuster M, MM Klein, HC Pribor, W Kozub: Brain abscess due to nocardia: report of a case. Arch Intern Med 120 (1967) 610–614

    PubMed  Google Scholar 

  55. Smith PW, GE Steinkraus, BW Hendricks: CNS nocardiosis: Response to sulfamethoxazole-trimethoprim. Arch Neurol 37 (1980) 729–730

    PubMed  Google Scholar 

  56. Stasiecki P, V Diehl, M Vlaho, GRF Krueger, KP Schaal: Neue erfolgreiche Therapie bei systemischer Infektion mit Nocardia asteroides. Dtsch Med Wochenschr 110 (1985) 1733–1737

    PubMed  Google Scholar 

  57. Stevens H: Actinomycosis of the nervous system. Neurology (Minneapolis) 3 (1953) 761–772

    Google Scholar 

  58. Turner E, JL Whitby: Nocardial cerebral abscess with systemic involvement successfully treated by aspiration and sulphonamides. J Neurosurg 31 (1969) 227–229

    PubMed  Google Scholar 

  59. Viroslav J, T Williams: Nocardial infection of the pulmonary and central nervous system: Successful treatment with medical therapy. South Med J 64 (1971) 1382–1385

    PubMed  Google Scholar 

  60. Weiss MH, JA Jane: Nocardia asteroides brain abscess successfully treated by enucleation. J Neurosurg 30 (1969) 83–86

    PubMed  Google Scholar 

  61. Welsh JD, ER Rhoades, W Jaques: Disseminated nocardiosis involving the spinal cord. Arch Intern Med 108 (1961) 73–79.

    PubMed  Google Scholar 

  62. Wren MV, AM Savage, RH Alford: Apparent cure of intracranial Nocardia asteroides infection by minocycline. Arch Intern Med 139 (1979) 249–250

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, University of Würzburg, Würzburg, West Germany

    Andreas Krone & Alexander Brawanski

  2. Department of Neuroradiology, University of Würzburg, Würzburg, West Germany

    Bernard Schuknecht

  3. Institute of Medical Microbiology and Immunology, University of Bonn, Bonn, West Germany

    Klaus P. Schaal

  4. Neurochirurgische Universitätsklinik, Josef Schneider-Straße 11, D-8700, Würzburg, West-Germany

    Andreas Krone

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  4. Bernard Schuknecht
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Krone, A., Schaal, K.P., Brawanski, A. et al. Nocardial cerebral abscess cured with imipenem/amikacin and enucleation. Neurosurg. Rev. 12, 333–340 (1989). https://doi.org/10.1007/BF01780852

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  • DOI: https://doi.org/10.1007/BF01780852

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