Nocardiosis of the Central Nervous System Experience From a General Hospital and Review of 84 Cases From the Literature


Abstract: Central nervous system (CNS) nocardiosis is a rare disease entity caused by the filamentous bacteria Nocardia species. We present a case series of 5 patients from our hospital and a review of the cases of CNS nocardiosis reported in the literature from January 2000 to December 2011. Our results indicate that CNS nocardiosis can occur in both immunocompromised and immunocompetent individuals and can be the result of prior pulmonary infection or can exist on its own. The most common predisposing factors are corticosteroid use (54 % of pa-tients) and organ transplantation (25%). Presentation of the disease is widely variable, and available diagnostic tests are far from perfect, often leading to delayed detection and initiation of treatment. The optimal therapeutic approach is still undetermined and depends on speciation, but lower mortality and relapse rates have been reported with a combi-nation of targeted antimicrobial treatment including trimethoprim/ sulfomethoxazole (TMP-SMX) for more than 6 months and neurosur-gical intervention. (Medicine 2014;93: 19Y32) Abbreviations: CMV = cytomegalovirus, CNS = central nervous system, COPD = chronic obstructive pulmonary disease, CSF = ce-rebrospinal fluid, CT = computed tomography, GVHD = graft-versus-host disease, HIV = human immunodeficiency virus, MGH = Massachusetts General Hospital, MRI = magnetic resonance imaging, PCR = polymerase chain reaction, TMP/SMX = trimethoprim/ sulfomethoxazole, TNF-> = tumor necrosis factor->

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