Öz
Nocardia infections are rarely encountered in healthy individuals causing opportunistic infections in people that for any reason have suppressed immune system. Central nervous system involvement usually develops secondary to lung infection and often appears in the form of cerebral abscess. The fact that it especially appears in immunocompromised patients, have more than one abscess,late diagnosis and delayed treatment increases the mortality rate. Furthermore, there are significant differences in susceptibilities to antibiotics between Nocardia species so, when they are isolated as a factor, maintaining without determining susceptibility patterns of started empirical antibiotic therapy leads to treatment failure. In this article we present a case of multifocal brain abscess.of a patient who takes immunosuppressive treatment from one year because of the systemic lupus erythematosus and two months before started anti-tuberculosis treatment because the pulmonary tuberculosis and is fully recovered by surgery and long-term co-trimoxazole treatment due to N. farcinica
Anahtar Kelimeler
Kaynakça
- Mamelak AN, Obana WG, Flaherty JF, et al. Nocardial brain abscess: treatment strategies and factors influ- encing outcome. Neurosurgery 1994;35(4): 622-31.
- Sorrell T, Mitchell D, Iredell J. Nocardia species. In: GL M, JE B, R D, editors. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 6 ed. Philadelphia: Churchill Livingstone; 2005. p. 2916-24.
- Kennedy KJ, Chung KH, Bowden FJ, et al. A cluster of nocardial brain abscesses. Surg Neurol 2007;68(1): 43-9.
- Lee GY, Daniel RT, Brophy BP, et al. Surgical treatment of nocardial brain abscesses. Neurosurgery. 2002;51(3): 668-71.
- Yamada SM, Nakai E, Toyonaga S, et al. A rapidly enlarging nocardial brain abscess mimicking malignant glioma. J Nippon Med Sch. 2005;72(5): 308-11.
- Sabuncuoglu H, Acikgoz ZC, Caydere M, et al. Nocardia farcinica brain abscess: a case report and review 2004;15(6):600-3. (Astur)
- Iannotti CA, Hall GS, Procop GW, et al. Solitary Nocardia farcinica brain abscess in an immuno- competent adult mimicking metastatic brain tumor: rapid diagnosis by pyrosequencing and successful treatment. Surgical neurology 2009;72(1):74-9.
- Brown-Elliott BA, Brown JM, Conville PS, et al. Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin Microbiol Rev. 2006; 19(2):259-82.
- Yildiz O, Alp E, Tokgoz B, et al. Nocardiosis in a teaching hospital in the Central Anatolia region of Turkey: treatment and outcome. Clin Microbiol Infect. 2005;11(6):495-9.
- Percin D, Sumerkan B, Inci R. Comparative Evaluation of E-Test and Disk Diffusion Methods for Susceptibility Testing 2011;45(2):274-9. Mikrobiyol Bul
- Wallace RJ, Tsukamura M, Brown BA, et al. Cefotaxime-resistant Nocardia asteroides strains are isolates of the controversial species Nocardia farcinica. J Clin Microbiol. 1990;28(12): 2726-32.
Öz
Nocardia enfeksiyonları sağlıklı bireylerde nadiren karşımıza çıkmakta olup immün sistemi herhangi bir nedenle baskılanmış kişilerde fırsatçı enfeksiyonlara neden olurar. Santral sinir sistemi tutulumu genellikle akciğer enfeksiyonuna sekonder gelişir ve en sık serebral apse şeklinde görülür. Özellikle immün sistemi baskılanmış hastalarda görülmesi, apse sayısının birden fazla olması tanının geç konulması ve tedavinin gecikmesi mortalite oranını artırmaktadır. Ayrıca Nocardia türleri arasında antibiyotik duyarlılıkları açısından önemli farklılıklar olduğu için, etken olarak izole edildiklerinde ampirik başlanan antibiyotik tedavisinin duyarlılık paternleri belirlenmeden devam ettirilmesi de tedavi başarısızlıklarına neden olmaktadır. Bu yazıda bir yıldır sistemik lupus eritematozis nedeniyle immünsupresif tedavi alan ve iki ay önce akciğer tüberkülozu nedeniyle anti-tüberküloz tedavisi alan bir hastada N. farcinica’nın etken olduğu, cerrahi ve uzun süreli ko-trimoksazol tedavisi ile tam iyileşen çok odaklı beyin apsesi olgusu sunulmuştur.
Anahtar Kelimeler
Kaynakça
- Mamelak AN, Obana WG, Flaherty JF, et al. Nocardial brain abscess: treatment strategies and factors influ- encing outcome. Neurosurgery 1994;35(4): 622-31.
- Sorrell T, Mitchell D, Iredell J. Nocardia species. In: GL M, JE B, R D, editors. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 6 ed. Philadelphia: Churchill Livingstone; 2005. p. 2916-24.
- Kennedy KJ, Chung KH, Bowden FJ, et al. A cluster of nocardial brain abscesses. Surg Neurol 2007;68(1): 43-9.
- Lee GY, Daniel RT, Brophy BP, et al. Surgical treatment of nocardial brain abscesses. Neurosurgery. 2002;51(3): 668-71.
- Yamada SM, Nakai E, Toyonaga S, et al. A rapidly enlarging nocardial brain abscess mimicking malignant glioma. J Nippon Med Sch. 2005;72(5): 308-11.
- Sabuncuoglu H, Acikgoz ZC, Caydere M, et al. Nocardia farcinica brain abscess: a case report and review 2004;15(6):600-3. (Astur)
- Iannotti CA, Hall GS, Procop GW, et al. Solitary Nocardia farcinica brain abscess in an immuno- competent adult mimicking metastatic brain tumor: rapid diagnosis by pyrosequencing and successful treatment. Surgical neurology 2009;72(1):74-9.
- Brown-Elliott BA, Brown JM, Conville PS, et al. Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin Microbiol Rev. 2006; 19(2):259-82.
- Yildiz O, Alp E, Tokgoz B, et al. Nocardiosis in a teaching hospital in the Central Anatolia region of Turkey: treatment and outcome. Clin Microbiol Infect. 2005;11(6):495-9.
- Percin D, Sumerkan B, Inci R. Comparative Evaluation of E-Test and Disk Diffusion Methods for Susceptibility Testing 2011;45(2):274-9. Mikrobiyol Bul
- Wallace RJ, Tsukamura M, Brown BA, et al. Cefotaxime-resistant Nocardia asteroides strains are isolates of the controversial species Nocardia farcinica. J Clin Microbiol. 1990;28(12): 2726-32.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Olgu Sunumları |
| Yazarlar | |
| Yayımlanma Tarihi | 16 Kasım 2015 |
| Yayımlandığı Sayı | Yıl 2014 Cilt: 2 Sayı: 2 |
