Nocardiosis (central nervous system manifestations)
Central nervous system (CNS) nocardiosis is a rare infection that may affect both the brain and the spine in patients with immunodeficiency.
CNS nocardiosis has been reported to represent ~2% of all cerebral abscesses, and to be present in 15-50% of patients with systemic infection 2-3.
Symptoms may vary according to the type of presentation and its extension in the CNS: headache, nausea, vomiting, focal neurological deficit and seizures are reported as the most common 2-3.
Nocardia spp. are aerobic and gram-positive bacilli which are saprophytic organisms ubiquitous in nature 1-3. The infection is acquired primarily by inhalation of the bacillus from the environment, then it can spread hematogenously to other organs and tissues 1-2. In the CNS the infection manifests as meningitis, granuloma with giant cells or cerebral abscesses 2.
Identification of Nocardia spp. in the clinical laboratory can be challenging: the organism may growth on cultures in intervals between 4 days to 2–4 weeks 1.
This infection has no specific features to aid in suggesting the diagnosis. It typically manifests as a parenchymal abscess in any part of the brain, although spinal cord abscesses and meningitis have also been described 1,2.
- 1. Kranick SM, Zerbe CS. Case report from the NIH Clinical Center: CNS nocardiosis. J. Neurovirol. 2013;19 (5): 505-7. doi:10.1007/s13365-013-0193-7 - Free text at pubmed - Pubmed citation
- 2. Zakaria A, Elwatidy S, Elgamal E. Nocardia brain abscess: severe CNS infection that needs aggressive management; case report. Acta Neurochir (Wien). 2009;150 (10): 1097-101. doi:10.1007/s00701-008-0026-2 - Pubmed citation
- 3. Chedid MB, Chedid MF, Porto NS et-al. Nocardial infections: report of 22 cases. Rev. Inst. Med. Trop. Sao Paulo. 2008;49 (4): 239-46. Pubmed citation