SUPERFICIAL CUTANEOUS ABSCESS AND MULTIPLE BRAIN ABSCESSES FROM NOCARDIA ASTEROIDES IN AN IMMUNOCOMPETENT PATIENT

Background:Scedosporial infections are usually encountered in the immunocompromised patients. However, they are now emerging in the immunocompetent population and have an affinity for the central nervous system. They represent a therapeutic challenge, since they are highly resistant to most antifungal medications.Methods:We report the case of an immunocompetent patient with multiple cerebral abscesses secondary to Scedosporium apiospermum following extracorporeal membrane oxygenation (ECMO) and review the literature about this challenging cerebral infection.Results:A previously healthy 33-year-old male admitted to the hospital for a community-acquired pneumonia requiring ECMO subsequently developed multiple cerebral abscesses. He was empirically treated with caspofungin, which was changed to voriconazole once surgical aspiration revealed Scedosporium apiospermum. Despite multiple aspirations, decompressive craniectomy to alleviate intracranial pressure, and an appropriate antifungal agent, the patient did not survive this aggressive infection.Conclusion:Brain abscesses with Scedosporium apiospermum present a therapeutic challenge. High clinical suspicion leading to early appropriate antifungal therapy and combined surgical interventions might improve the prognosis.

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Nocardia asteroides brain abscesses and meningitis in an immunocompromized 10-year-old child

Scandinavian Journal of Infectious Diseases ◽

10.1080/00365540510038965 ◽

2005 ◽

Vol 37 (6-7) ◽

pp. 511-513 ◽

Cited By ~ 14

Author(s):

Emilie Chow ◽

Theodore Moore ◽

Jaime Deville ◽

Karin Nielsen

Keyword(s):

Nocardia Asteroides ◽

Brain Abscesses

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Lung Abscess With Metastatic Brain Abscesses (MBA) Due to Steptococcus Anginosus (SA) in an Immunocompetent Patient: A Rare Case Report

CHEST Journal ◽

10.1016/j.chest.2016.08.196 ◽

2016 ◽

Vol 150 (4) ◽

pp. 187A

Author(s):

Ahad Ayaz ◽

Chintan Desai ◽

Siddique Chaudhary ◽

John Youssef ◽

Susan Smith

Keyword(s):

Case Report ◽

Rare Case ◽

Immunocompetent Patient ◽

Lung Abscess ◽

Rare Case Report ◽

Brain Abscesses

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ABORDAGEM TERAPEUTICA DE ABSCESSOS CEREBRAIS MÚLTIPLOS DE CAUSA IDIOPÁTICA EM PACIENTE IMUNOCOMPETENTE: RELATO DE CASO.

Revista de Patologia do Tocantins ◽

10.20873/uft.2446-6492.2018v5n4p23 ◽

2018 ◽

Vol 5 (4) ◽

pp. 23-27

Author(s):

Ermilton Barreira Parente Júnior ◽

Marlon Daniel Gomes Coelho ◽

Thais Mahassem Cavalcante de Macedo Parente ◽

Olivia Maria Veloso Coutinho ◽

Oscar Nunes Alves

Keyword(s):

Antibiotic Therapy ◽

Rare Case ◽

Mass Effect ◽

Immunocompetent Patient ◽

Etiologic Agent ◽

Evolutionary Stage ◽

Temporal Region ◽

Empirical Antibiotic Therapy ◽

Brain Abscesses ◽

The Right

Introdução: Abscessos cerebrais múltiplos são focos de infecções piogênicas do parênquima cerebral que requerem uma atenção imediata e eficaz para reducão de morbimortalidade. A identificação do agente etiológico e do foco infeccioso normalmente é de grande valia na programação terapêutica. Esse trabalho busca relatar um raro caso de abscessos cerebrais múltiplos em paciente imunocompetente e sem fatores de risco evidentes, e o papel fundamental da antibioticoterapia empírica na resolução do caso. Relato do caso: Paciente, 75 anos, sem evidência de imunossupressão e doenças prévias iniciou quadro de alterações das atividades básicas da vida diária, confusão de tempo e espaço, hipersonia, lentificação da marcha, disartria e dor em pontada na região temporal direita que não cessava ao uso de analgésicos. Em Ressôncia magnética evidenciou-se múltiplos abscessos em região temporal gerando efeito de massa e hipertensão intracraniana. Realizado craniotomias com drenagens de secreções purulentas e culturas do material que não identificaram o agente etiológico. Discussão: A abordagem terapêutica dos abscessos cerebrais ainda não se encontra definida. Em virtude disso, cada caso tem sido conduzido de forma individualizada de acordo com a localização das lesões, seu estágio evolutivo e as condições clínicas do paciente. No caso em questão não indentificou-se a origem dos abscessos e a resolução do quadro foi obtida através das drenagens cirúrgicas em associação a antibioticoterapia empírica. Com os avanços da neuroimagem e da farmacologia, a redução da mortalidade por abscessos cerebrais reduziu para menos de 10%. Porém, a não identificação de um agente etiológico e diversas abordagens neurocirúrgicas podem acarretar em mais comorbidades para o paciente. Apresentamos um raro caso de abcessos cerebrais em paciente imunocompetente sem identificação de organismo agressor e o papel da antibioticoterapia empírica na resolução do caso. Palavras-chave: abscesso encefálico; imunocompetência; diagnóstico; terapêutica; antimicrobianos. ABSTRACT Introduction: Multiple brain abscesses are centers of pyogenic cerebral parenchymal infections that require immediate and effective attention to reduce morbidity and mortality. The identification of the etiologic agent and the infectious focus are usually of great value in terms of therapeutic planning. This paper seeks to report a rare case of multiple brain abscesses in an immunocompetent patient with no evident risk factors and the fundamental role that empirical antibiotic therapy plays in the resolution of the case. Case report: A 75-year-old patient with no evidence of immunosuppression and previous illnesses began to experience changes in her basic daily live activities, confusion in time and space, hypersomnia, gait slowing, dysarthria and stabbing pain in the right temporal region of the brain that would not cease even with use of analgesics. Magnetic Resonance revealed multiple abscesses in the temporal region generating mass effect and intracranial hypertension. It was performed craniotomies with drainage of purulent secretions and it was prepared cultures out of the material which resulted in no identification of the etiological agent. Discussion: The therapeutic approach of brain abscesses has not yet been defined. As a result, each case has been conducted in an individualized manner according to the location of the lesions, their evolutionary stage and the patient's clinical conditions. In the case of this report, the abscess’ origin was not identified and the resolution of the condition was obtained through surgical drainage in association with empirical antibiotic therapy. With advances in neuroimaging and pharmacology, reduction in mortality from brain abscesses reduced to less than 10%. However, failure to identify an etiologic agent and several neurosurgical approaches may lead to more comorbidities for the patient. We present a rare case of cerebral abscesses in an immunocompetent patient without identification of an aggressor organism and the importance of empirical antibiotic therapy in the resolution of the case. Keywords: brain abscess; immunocompetence; diagnosis; therapeutics; anti-infective agents.

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1084. Nocardia Cyriacigeorgica Endocarditis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.919 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S324-S325

Author(s):

Nikhil Bhayani ◽

Jaclyn Priest

Keyword(s):

Dna Sequencing ◽

Suppressive Therapy ◽

Nocardia Asteroides ◽

Chronic Obstructive ◽

Gram Positive ◽

Obstructive Pulmonary Disease ◽

Nocardia Cyriacigeorgica ◽

The Family ◽

Brain Abscesses ◽

Slow Growing

Abstract Background Nocardia are beaded, branching Gram-positive rods that are partially acid fast and usually slow growing. Nocardia cyriacigeorgica was first described in 2001, and antimicrobial susceptibility patterns correspond with type VI Nocardia asteroides complex. Nocardia species are not a commonly associated with endocarditis, less than 20 cases to date have been documented. However, when Nocardia endocarditis is identified, the mortality rate is reported to be as high as 41% making antibiotic selection vital in the inpatient and outpatient Methods A 62-year-old male with a past medical history significant for severe chronic obstructive pulmonary disease (COPD), atrial fibrillation, atrial tachyarrhythmia, and congestive heart failure (CHF) presented to the emergency department (ED) with shortness of breath for 1 week. The patient was initiated on IV diltiazem, meropenem, and eventually required intubation. On hospital day, two blood cultures grew Gram-positive rods, which were eventually identified as aerobic Actinomycete. Culture was sent out for DNA sequencing and N. cyriacigeorgica was identified. Transthoracic echocardiogram showed possible mitral vegetation. Results Antimicrobial therapy was initially de-escalated from meropenem to ampicillin, but had to be escalated to ceftriaxone once N. cyriacigeorgica was identified by DNA sequencing. The organism was reported to be susceptible to amikacin, ceftriaxone, linezolid, tobramycin, and trimethoprim/sulfamethoxazole. The patient received 1 week of ceftriaxone therapy inpatient, and was discharged on an additional 3 weeks of ceftriaxone and 6 months of minocycline suppressive therapy. Two months later the patient was re-admitted for N. cyriacigeorgica bacteremia and a pulmonary embolism. During his hospital stay, the patient had a STEMI, but due to multiple comorbidities did not undergo cardiac catheterization. The family elected to withdrawal care, and the patient expired. Conclusion N. cyriacigeorgica is more commonly identified in brain abscesses or skin infections, in the setting of immunosuppression. We report here on an unusual case of N. cyriacigeorgica endocarditis in a patient with COPD. Other than COPD the patient had no known risk factors for N. cyriacigeorgica, including chronic steroid use. Disclosures All authors: No reported disclosures.

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Klebsiella brain abscess in an immunocompetent patient: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02633-0 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Clay Wu ◽

Semi Han ◽

Ahmet Baydur ◽

Brett Lindgren

Keyword(s):

Computed Tomography ◽

Klebsiella Pneumoniae ◽

Brain Abscess ◽

Mental Status ◽

Klebsiella Oxytoca ◽

Brain Magnetic Resonance Imaging ◽

Altered Mental Status ◽

Immunocompetent Patient ◽

Normal Limits ◽

Brain Abscesses

Abstract Background Klebsiella pneumoniae brain abscesses are a rare entity and typically present in immunocompromised patients. We present a case of an overall healthy patient who developed a Klebsiella pneumoniae brain abscess in the absence of liver pathology. Case presentation A 46-year-old Vietnamese man with past medical history significant for hypertension presented to the hospital with acute on chronic worsening of altered mental status, personality changes, and gait dysfunction. Initial vitals revealed temperature of 37.1 °C, heart rate 87 beats/minute, blood pressure 150/87 mmHg, respiratory rate 18/minute, and oxygen saturation 99% on room air. Physical exam was notable for altered mental status, Glasgow Coma Scale (GCS) score of 14, and right lower facial droop. Cardiopulmonary exam was within normal limits. Head computed tomography (CT) showed a left frontotemporal mass, with subsequent brain magnetic resonance imaging (MRI) revealing a ring-enhancing lesion concerning for a brain abscess. The abscess was urgently drained; however, there was intraoperative spillage into the ventricles. Intraoperative cultures grew Klebsiella pneumoniae, and the patient was maintained on appropriate antibiotics. He developed worsening mental status, septic shock, and cerebral edema requiring decompressive left hemicraniectomy. Computed tomography of the abdomen and pelvis revealed no hepatic lesions. The patient did not improve, and the family elected for comfort measures. Conclusion High mortality is associated with Klebsiella pneumoniae (as opposed to Klebsiella oxytoca) brain abscesses, especially in the setting of intraventricular spread. This case illustrates the need for early detection, and an aggressive medical and surgical treatment approach is required for a potential favorable outcome.

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