RESUMO
The identification of Nocardia transvalensis, an unusual and probably underrecognized cause of nocardial infection, is clinically significant because of this species' resistance to aminoglycosides, a standard antinocardial therapy. Diagnosis requires analytic methods available predominately in reference laboratories. We report a case of disseminated infection with N transvalensis with primary pulmonary involvement and subsequent development of brain abscesses, and review the literature to date. Familiarity with the epidemiology, pathologic findings, and clinical significance of this and other unusual Nocardia species may increase early identification and antibiotic susceptibility testing in cases of nocardial infection.
Assuntos
Abscesso Encefálico/diagnóstico , Infecções Bacterianas do Sistema Nervoso Central/diagnóstico , Nocardiose/diagnóstico , Aminoglicosídeos , Antibacterianos/metabolismo , Antibacterianos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/microbiologia , Abscesso Encefálico/cirurgia , Neoplasias Encefálicas/microbiologia , Neoplasias Encefálicas/cirurgia , Núcleo Caudado/irrigação sanguínea , Núcleo Caudado/microbiologia , Núcleo Caudado/patologia , Núcleo Caudado/cirurgia , Infecções Bacterianas do Sistema Nervoso Central/tratamento farmacológico , Infecções Bacterianas do Sistema Nervoso Central/epidemiologia , Infecções Bacterianas do Sistema Nervoso Central/cirurgia , Fossa Craniana Posterior/irrigação sanguínea , Fossa Craniana Posterior/microbiologia , Fossa Craniana Posterior/patologia , Fossa Craniana Posterior/cirurgia , Craniotomia/métodos , Farmacorresistência Bacteriana/fisiologia , Evolução Fatal , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/cirurgia , Masculino , Pessoa de Meia-Idade , Nocardia/efeitos dos fármacos , Nocardia/crescimento & desenvolvimento , Nocardia/isolamento & purificação , Nocardiose/tratamento farmacológico , Nocardiose/epidemiologia , Nocardiose/cirurgia , Lobo Occipital/irrigação sanguínea , Lobo Occipital/microbiologia , Lobo Occipital/patologia , Lobo Occipital/cirurgia , Especificidade da Espécie , Telencéfalo/irrigação sanguínea , Telencéfalo/microbiologia , Telencéfalo/patologia , Telencéfalo/cirurgia , Vasculite do Sistema Nervoso Central/diagnóstico , Vasculite do Sistema Nervoso Central/microbiologiaRESUMO
Light and electron microscopic observation 3--4 days after microinjection of Herpes simplex virus (HSV) into the left neostriatum of rat demonstrated the following results. (1) Virus labeled nerve cells were found in the ipsilateral substantia nigra; a large number of infected neurons were in the zona compacta and some were in the zona reticulata. No virus infection was evident in the contralateral side. (2) Virus labeled neurons were found in the cortex, a greater number ipsilaterally than contralaterally, and in the dorsal raphé nuclei. Cortical microinjection of HSV led to infection of some cortical cells but no neostriatal cells. We conclude, therefore, that spread of the virus to the cortex, the substantia nigra and the dorsal raphé following neostriatal injection was by retrograde axonal transport. (3) The left neostriatum, where HSV was injected, showed a surprisingly small number of virus infected neurons. The infected neurons were mostly the large neurons; the majority of medium sized neurons were well preserved. There was massive degeneration of nerve terminals throughout the neuropil. Most of these degenerating nerve terminals are considered to be afferent fibers.