Idiopathic thrombocytopenic purpura with brain abscess caused by Nocardia farcinica diagnosed using metagenomics next-generation sequencing of the cerebrospinal fluid: a case report.

BACKGROUND: Brain abscesses caused by Nocardia farcinica are rare, and mostly occur in immunocompromised individuals. Rapid and accurate diagnosis of nocardiosis is challenging. Due to the inadequate performance of conventional diagnostic methods for Nocardia infection, metagenomics next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) has the potential to improve the diagnosis intracranial nocardiosis. CASE PRESENTATION: We report a case of 50-year-old man with brain abscess caused by Nocardia farcinica. The patient had a idiopathic thrombocytopenic purpura complication that required long-term methylprednisolone administration. His chest image showed multiple lesions, which had been misdiagnosed as lung cancer, and his head image showed multiple intracranial metastases. No pathogen was detected in routine examinations including blood culture, sputum culture and traditional culture methods of cerebrospinal fluid. In order to accurately identify the pathogen, mNGS was used to detect Nocardia in CSF. Although the patient's condition improved after using sensitive antibiotics, he transferred to the local hospital for treatment because of many complicated diseases and family financial limitations. CONCLUSION: This case highlights the value of mNGS in the diagnosis of Nocardia brain abscess, and emphasizes the inadequate sensitivity of conventional diagnostic methods for Nocardia infection. Using mNGS can facilitate early and accurate detection of Norcadia-associated of meningitis in immunocompromised patients, thereby reducing unnecessary use of antibiotics and reducing mortality of the disease.

Disseminated nocardiosis after unrelated bone marrow transplantation.

Nocardiosis is a rare bacterial infection occurring mainly in patients with deficient cell-mediated immunity. Although disseminated nocardiosis after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a rare complication, it is associated with high mortality. Moreover, after allo-HSCT, nocardiosis may be mistaken for other bacterial or fungal infections because clinical and radiographic findings of pulmonary, cerebral, and cutaneous nocardiosis lesions are non-specific. Here, we report a case of disseminated nocardiosis (caused by Nocardia abscessus) with skin, pulmonary, liver, lymph node, and multiple brain abscesses in a patient after allo-HSCT. The patient initially responded clinically and radiographically to imipenem/cilastin and trimethoprim-sulfamethoxazole therapy. Clinicians should be aware of the possibility of nocardiosis in allo-HSCT recipients who are treated with multiple immunosuppressive agents to control chronic graft-versus-host disease. Accurate diagnosis and identification of disseminated nocardiosis is important to ensure administration of the correct antibiotic regimen.

Primary Nocardia meningitis in a patient without a predisposing condition: case report and review of the literature.

A case of primary Nocardia meningitis in a patient without a predisposing condition is presented and 4 other reported cases are reviewed. The presenting features were fever, headache, altered consciousness, and neck stiffness. Cerebrospinal fluid examination (CSF) revealed hypoglycorrhachia (<40 mg/dl), elevated protein (>100 mg/dl), and pleocytosis with predominant neutrophils in all patients. Culture of CSF was positive for Nocardia in 4 of the 5 patients. Mortality was 50%. Diagnosis was frequently delayed and this probably contributed to the high mortality. Compared with Nocardia meningitis in association with a predisposing condition, primary Nocardia meningitis without a predisposing condition has similar clinical features and outcome.

Syringomyelia presenting as a delayed complication of treatment for nocardia brain abscess.

OBJECTIVE: Syringomyelia is defined as a dilatation of the central canal of the spinal cord which often leads to neurologic impairment. Syringomyelia has not previously been reported as a late complication for the treatment of brain abscess. In this report, we review a case involving this unusual association. CLINICAL PRESENTATION: A 25 year-old woman sustained a nocardia brain abscess initially presenting as a pulmonary infection. Treatment led to the development of multiloculated hydrocephalus and syringomyelia. INTERVENTION: Treatment included placement of multiple ventriculoperitoneal shunts and a syringo-pleural shunt. This resulted in stabilization of neurologic symptoms. CONCLUSION: The possibility of developing syringomyelia should be considered in any case involving post-infectious hydrocephalus.

Detection of metabolites by frequency-pulsed electron capture gas-liquid chromatography in serum and cerebrospinal fluid of a patient with Nocardia infection.

Serum (SR) and cerebrospinal fluid (CSF) from a patient suspected of having tuberculous meningitis were submitted to our laboratory for analysis by frequency-pulsed electron capture gas-liquid chromatography (FPEC GLC). The samples were tested for the presence of carboxylic acids, alcohols, hydroxy acids, and amines by methods described previously (C. C. Alley, J. B. Brooks, and D. S. Kellogg, Jr., J. Clin. Microbiol. 9:97-102, 1977; J. B. Brooks, C. C. Alley, and J. A. Liddle, Anal. Chem. 46:1930-1934, 1974; J. B. Brooks, D. S. Kellogg, Jr., M. E. Shepherd, and C. C. Alley, J. Clin. Microbiol. 11:45-51, 1980; J. B. Brooks, D. S. Kellogg, Jr., M. E. Shepherd, and C. C. Alley, J. Clin. Microbiol. 11:52-58, 1980). The results were different from previous FPEC GLC profiles of SR and CSF from patients with known tuberculous meningitis. Both the SR and CSF contained several unidentified compounds that were not previously detected in tuberculous meningitis or any of our other studies of body fluids. Nocardia brasiliensis was later isolated from the patient. Detection of these metabolites by FPEC GLC could prove to be useful for rapid diagnosis of Nocardia disease, and their identification will provide a better understanding of metabolites produced by Nocardia sp. in vivo.

Ventricular peritoneal shunt infection caused by a member of the rhodochrous complex.

Microorganisms of the rhodochrous complex were isolated in pure culture from a ventricular peritoneal shunt in a 5.5-month-old child.