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Ehara T, Suzuki T, Mizuno R, Shirahata M, Mishima K, Homma T. Rapidly Progressing Intramedullary Spinal Cord Abscess: A Case Report. NMC Case Rep J 2024; 11:43-47. [PMID: 38454915 PMCID: PMC10917654 DOI: 10.2176/jns-nmc.2023-0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/05/2023] [Indexed: 03/09/2024] Open
Abstract
Intramedullary spinal cord abscess is a rare and severe infectious disease characterized by devastating neurological deficits. We report a case of cervical intramedullary spinal cord abscess in a 74-year-old diabetic male with a 3-day history of neck pain and weakness in the right lower extremity. Magnetic resonance imaging revealed a ring-shaped contrast lesion in C3-C6 of the cervical spinal cord with extensive edema. Further, 1 day after admission, he became comatose (Glasgow Coma Scale E1VtM1), and a computed tomography head scan revealed hydrocephalus. Despite emergency ventricular drainage, the patient's level of consciousness remained unchanged. Magnetic resonance imaging performed 1 day after surgery revealed bilateral intracranial extension of the abscess into the thalamus and caudate nucleus. The patient died 19 days after admission. Our report is the first case of extensive brain abscess development over a short period. Based on our experience, prompt administration of antibiotics and emergency abscess drainage of the cervical cord (and ventricular drainage, if necessary) are recommended in cases of neurological deterioration in patients with cervical intramedullary spinal cord abscess.
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Affiliation(s)
- Takuro Ehara
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Tomonari Suzuki
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Reina Mizuno
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Mitsuaki Shirahata
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Taku Homma
- Department of Pathology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
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2
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Satyadev N, Moore C, Khunkhun SK, Aggarwal K, Osman M, Protas M, Abi-Aad K, Goulart CR, Rai SS, Galgano MA. Intramedullary Spinal Cord Abscess Management: Case Series, Operative Video, and Systematic Review. World Neurosurg 2023; 174:205-212.e6. [PMID: 36898628 DOI: 10.1016/j.wneu.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Intramedullary spinal cord abscess (ISCA) is an extremely rare disease, which has had fewer than 250 reported cases since its initial description in 1830. The condition is limited to level V evidence, limiting the ability for surgeons to characterize and treat it. OBJECTIVE To report the cases of 2 patients with ISCA and their surgical management: a 59-year-old woman who presented with progressive right hemiparesis and a 69-old man who presented with acute gait instability and significant bilateral shoulder pain. In addition, to report findings from a systematic literature review and associated logistic regression analysis. METHODS A MEDLINE and Embase search was conducted using the keywords "intramedullary," "spinal cord," "abscess," and "tuberculoma" and the results were screened for case reports. A logistic regression model was fit 100 times on data to retrieve predictor odds ratios. RESULTS Two hundred case reports of ISCA were identified between 1965 and 2022. Logistic regression determined that the only variables of significance were age (P < 0.01) and antibiotics (P < 0.05). CONCLUSIONS Treatment of ISCAs has significantly improved over the years. However, ISCAs are still poorly understood. Our recommendations can be used to guide diagnosis and treatment.
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Affiliation(s)
- Nihal Satyadev
- University of Medicine and Health Sciences, Basseterre, St. Kitts and Nevis.
| | | | | | | | - Masha Osman
- St. George's University, St. George, Grenada
| | - Matthew Protas
- Department of Neurosurgery, SUNY Upstate Medical University, New York, New York, USA
| | - Karl Abi-Aad
- Department of Neurosurgery, SUNY Upstate Medical University, New York, New York, USA
| | - Carlos R Goulart
- Department of Neurosurgery, SUNY Upstate Medical University, New York, New York, USA; Department of Neurosurgery, Essential Health, Duluth, Minnesota, USA
| | - Shawn S Rai
- Department of Neurosurgery, SUNY Upstate Medical University, New York, New York, USA; Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Michael A Galgano
- Department of Neurosurgery, SUNY Upstate Medical University, New York, New York, USA; Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
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3
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Jabbar R, Szmyd B, Jankowski J, Lusa W, Pawełczyk A, Wysiadecki G, Tubbs RS, Iwanaga J, Radek M. Intramedullary Spinal Cord Abscess with Concomitant Spinal Degenerative Diseases: A Case Report and Systematic Literature Review. J Clin Med 2022; 11:jcm11175148. [PMID: 36079075 PMCID: PMC9457049 DOI: 10.3390/jcm11175148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/10/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Intramedullary spinal cord abscess (ISCA) is a rare clinical pathology of the central nervous system that usually accompanies other underlying comorbidities. Traditionally it has been associated with significant mortality and neurological morbidities because it is often difficult to diagnose promptly, owing to its nonspecific clinical and neuroimaging features. The mortality rate and the outcome of these infections have been improved by the introduction into clinical practice of antibiotics, advanced neuroimaging modalities, and immediate surgery. We report the case of a 65-year-old male patient who presented with a progressive spastic gait and lumbar pain, predominantly in the left leg. An MRI image revealed an expansile intramedullary cystic mass in the thoracic spinal cord, which was initially diagnosed as a spinal tumor. He underwent laminectomy and myelotomy, and eventually the pus was drained from the abscess. The follow-up MRI showed improvement, but the patient’s paraplegia persisted. In light of his persistent hypoesthesia and paraplegic gait with developing neuropathic pain, he was readmitted, and an MRI of his lumbar spine revealed multilevel degenerative disease and tethered spinal cord syndrome with compression of the medulla at the L2–L3 level. The patient underwent central flavectomy with bilateral foraminotomy at the L2–L3 level, and the medulla was decompressed. Postoperatively, his neurological symptoms were significantly improved, and he was discharged from hospital on the third day after admission. In support of our case, we systematically reviewed the recent literature and analyzed cases published between 1949 and May 2022, including clinical features, mechanisms of infection, predisposing factors, radiological investigations, microbial etiologies, therapies and their duration, follow-ups, and outcomes. Initial clinical presentation can be misleading, and the diagnosis can be challenging, because this condition is rare and coexists with other spinal diseases. Hence, a high index of suspicion for making an accurate diagnosis and timely intervention is required to preclude mortality and unfavorable outcomes. Our case is a clear example thereof. Long-term follow-up is also essential to monitor for abscess recurrences.
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Affiliation(s)
- Redwan Jabbar
- Department of Neurosurgery, Spine and Peripheral Nerves Surgery, Medical University of Lodz, 90-549 Lodz, Poland
| | - Bartosz Szmyd
- Department of Neurosurgery, Spine and Peripheral Nerves Surgery, Medical University of Lodz, 90-549 Lodz, Poland
| | - Jakub Jankowski
- Department of Neurosurgery, Spine and Peripheral Nerves Surgery, Medical University of Lodz, 90-549 Lodz, Poland
| | - Weronika Lusa
- Department of Neurosurgery, Spine and Peripheral Nerves Surgery, Medical University of Lodz, 90-549 Lodz, Poland
- Department of Clinical Chemistry and Biochemistry, Medical University of Lodz, 90-419 Lodz, Poland
| | - Agnieszka Pawełczyk
- Department of Neurosurgery, Spine and Peripheral Nerves Surgery, Medical University of Lodz, 90-549 Lodz, Poland
| | - Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Żeligowskiego 7/9, 90-752 Lodz, Poland
| | - R. Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA 70433, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA
- Department of Anatomical Sciences, St. George’s University, Grenada FZ 818, West Indies
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Maciej Radek
- Department of Neurosurgery, Spine and Peripheral Nerves Surgery, Medical University of Lodz, 90-549 Lodz, Poland
- Correspondence:
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Warsi NM, Wilson A, Malhotra AK, Ku JC, Najjar AA, Bui E, Baker M, Bartlett E, Hodaie M. Cryptogenic cervical intramedullary abscess with rapidly progressive myelopathy: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 1:CASE2035. [PMID: 36131588 PMCID: PMC9628101 DOI: 10.3171/case2035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND The purpose of the present case report is to highlight the presentation, workup, clinical decision making, and operative intervention for a 68-year-old woman who developed rapidly progressive myelopathy secondary to idiopathic cervical intramedullary abscess. OBSERVATIONS The patient underwent laminectomy and aspiration/biopsy of the lesion. Intraoperatively, division of the posterior median sulcus released a large volume of purulent material growing the oral pathogens Eikenella corrodens and Gemella morbillorum. Broad-spectrum antibiotics were initiated postoperatively. At the 6-month follow-up, the patient had almost completely recovered with some persistent hand dysesthesia. Complete infectious workup, including full dental assessment and an echocardiogram, failed to reveal the source of her infection. LESSONS The authors report the first case of cryptogenic spinal intramedullary abscess secondary to Eikenella spp. and Gemella spp. coinfection. Intramedullary abscesses are exceptionally rare and most commonly develop in children with dermal sinus malformations or in the context of immunosuppression. In adults without risk factors, they can readily be mistaken for more common pathologies in this age group, such as intramedullary neoplasms or demyelinating disease. Prompt diagnosis and management based on rapidly progressive myelopathy, assessment of infectious risk factors and/or symptoms, and targeted imaging are critical to avoid potentially devastating neurological sequelae.
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Affiliation(s)
- Nebras M. Warsi
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ann Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Armaan K. Malhotra
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jerry C. Ku
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed A. Najjar
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Esther Bui
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; and
| | - Michael Baker
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; and
| | - Eric Bartlett
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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5
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Restrepo A, Clark NM. Nocardia infections in solid organ transplantation: Guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation. Clin Transplant 2019; 33:e13509. [PMID: 30817024 DOI: 10.1111/ctr.13509] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/12/2019] [Indexed: 12/29/2022]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of Nocardia infections after solid organ transplantation (SOT). Nocardia infections have increased in the last two decades, likely due to improved detection and identification methods and an expanding immunocompromised population. The risk of developing nocardiosis after transplantation varies with the type of organ transplanted and the immunosuppression regimen used. Nocardia infection most commonly involves the lung. Disseminated infection can occur, with spread to the bloodstream, skin, or central nervous system. Early recognition of the infection and initial appropriate treatment is important to achieve good outcomes. Species identification and antimicrobial susceptibility testing are strongly recommended, as inter- and intraspecies susceptibility patterns can vary. Sulfonamide is the first-line treatment of Nocardia infections, and combination therapy with at least two antimicrobial agents should be used initially for disseminated or severe nocardiosis. Trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis may be helpful in preventing Nocardia infection after SOT.
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Affiliation(s)
- Alejandro Restrepo
- Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Nina M Clark
- Division of Infectious Diseases, Department of Medicine, Loyola University Stritch School of Medicine, Maywood, Illinois
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6
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Freiberg JA, Saharia KK, Morales MK. An unusual case of Nocardia cyriacigeorgica presenting with spinal abscesses in a renal transplant recipient and a review of the literature. Transpl Infect Dis 2018; 21:e13025. [PMID: 30414295 DOI: 10.1111/tid.13025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/05/2018] [Accepted: 10/28/2018] [Indexed: 01/28/2023]
Abstract
Nocardia species represent a well-recognized yet uncommon cause of opportunistic infections in humans. It most frequently presents as a pulmonary infection with or without central nervous system involvement. It is a very rare cause of spinal abscesses, with only 26 cases reported in the literature. Here we report a 49-year-old man with a history of renal transplantation who presented with low back pain and was diagnosed with epidural and paraspinal abscesses due to Nocardia cyriacigeorgica that was successfully treated with antimicrobial therapy alone. In addition to the case reported here, we also conducted a systematic review of the existing literature regarding spinal abscesses due to Nocardia species and examined the success of the various treatments utilized.
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Affiliation(s)
| | - Kapil K Saharia
- Institute of Human Virology and Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland
| | - Megan K Morales
- Institute of Human Virology and Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland
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7
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Peeters I, Casselman JW, Vandecasteele SJ, Janssen A, Regaert B, Vantomme N, Vanopdenbosch LJ. Multiple nocardial abscesses of the brainstem and spinal cord diagnosed after an open biopsy through a cervical partial central corpectomy: case report. J Neurosurg Spine 2015; 23:290-3. [DOI: 10.3171/2014.12.spine14755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nocardiosis of the central nervous system is a challenging and difficult diagnosis for the clinician. The combination of infections of the brain and spinal cord is even more rare. The authors report on a patient with multiple lesions in the brainstem and cervical spinal cord. This 81-year-old immunocompetent woman presented with symptoms of progressive walking difficulty and ataxia. The results of an extensive workup with laboratory investigation, MRI, lumbar puncture, positron emission tomography (PET), and bone marrow biopsy remained inconclusive. Only after an open biopsy of a cervical lesion by an anterior approach through a partial central corpectomy of the cervical spine, was the diagnosis of nocardiosis made, allowing for specific antibiotic treatment.
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Affiliation(s)
| | | | | | | | - Bart Regaert
- 4Neurosurgery, Hospital AZ Sint-Jan, Brugge, Belgium
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8
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Beuret F, Schmitt E, Planel S, Lesanne G, Bracard S. Subtentorial cerebral nocardiosis in immunocompetent patients: CT and MR imaging findings. Diagn Interv Imaging 2015; 96:953-7. [PMID: 25981212 DOI: 10.1016/j.diii.2015.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/26/2015] [Accepted: 03/27/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe the clinical presentation and computed tomography (CT) and magnetic resonance imaging (MRI) appearances of subtentorial nocardia cerebral abscesses developing in immunocompetent patients. PATIENTS AND METHODS The clinical findings and the results of CT and MRI examinations of three immunocompetent patients with nocardiosis located initially only in the subtentorial region were studied. Three patients underwent CT examination and two patients had MRI. RESULTS Clinically, two patients had cerebellar syndrome and the third had meningism with fever. The diagnosis of nocardiosis was bacteriologically confirmed by demonstrating the organism in lumbar puncture fluid in one patient and by an aspiration biopsy of the abscess in the other two. Two of the patients improved under targeted antibiotic therapy whereas the third patient died. The main imaging features of the lesions were a multiloculated appearance with peripheral enhancement after intravenous administration of iodinated contrast material on CT and a multicystic appearance on MRI, with a peripheral hypointense rim on T2-weighted images, a relatively minor mass effect and a multiloculated appearance on gadolinium-chelate enhanced T1-weighted images. CONCLUSION The clinical presentation of cerebral nocardiosis is relatively non-specific. A microcystic lesion surrounded by hypointensity on T2-weighted MR images with a multiloculated pattern after gadolinium chelate administration on T1-weighted MR images in association with a relatively minor mass effect should suggest this diagnosis even if the lesion is single and in the absence of immunosuppression.
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Affiliation(s)
- F Beuret
- Université de Lorraine, 54000 Nancy, France; Department of Diagnostic and Therapeutic Neuroradiology, hôpital Central, 29, avenue Maréchal-de-Lattre-de-Tassigny, 54035 Nancy cedex, France.
| | - E Schmitt
- Department of Diagnostic and Therapeutic Neuroradiology, hôpital Central, 29, avenue Maréchal-de-Lattre-de-Tassigny, 54035 Nancy cedex, France
| | - S Planel
- Université de Lorraine, 54000 Nancy, France; Department of Diagnostic and Therapeutic Neuroradiology, hôpital Central, 29, avenue Maréchal-de-Lattre-de-Tassigny, 54035 Nancy cedex, France
| | - G Lesanne
- Department of Diagnostic and Therapeutic Neuroradiology, hôpital Central, 29, avenue Maréchal-de-Lattre-de-Tassigny, 54035 Nancy cedex, France
| | - S Bracard
- Université de Lorraine, 54000 Nancy, France; IADI-Inserm U 947, Vandœuvre-lès-Nancy, France; Department of Diagnostic and Therapeutic Neuroradiology, hôpital Central, 29, avenue Maréchal-de-Lattre-de-Tassigny, 54035 Nancy cedex, France
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9
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Affiliation(s)
- Nabil Hussain
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Canada
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10
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Anagnostou T, Arvanitis M, Kourkoumpetis TK, Desalermos A, Carneiro HA, Mylonakis E. Nocardiosis of the central nervous system: experience from a general hospital and review of 84 cases from the literature. Medicine (Baltimore) 2014; 93:19-32. [PMID: 24378740 PMCID: PMC4616325 DOI: 10.1097/md.0000000000000012] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Central nervous system (CNS) nocardiosis is a rare disease entity caused by the filamentous bacteria Nocardia species. We present a case series of 5 patients from our hospital and a review of the cases of CNS nocardiosis reported in the literature from January 2000 to December 2011. Our results indicate that CNS nocardiosis can occur in both immunocompromised and immunocompetent individuals and can be the result of prior pulmonary infection or can exist on its own. The most common predisposing factors are corticosteroid use (54% of patients) and organ transplantation (25%). Presentation of the disease is widely variable, and available diagnostic tests are far from perfect, often leading to delayed detection and initiation of treatment. The optimal therapeutic approach is still undetermined and depends on speciation, but lower mortality and relapse rates have been reported with a combination of targeted antimicrobial treatment including trimethoprim/sulfomethoxazole (TMP-SMX) for more than 6 months and neurosurgical intervention.
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Affiliation(s)
- Theodora Anagnostou
- From Department of Medicine, Infectious Disease Division (TA, TKK, AD, HAC, EM), Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, and Department of Medicine, Infectious Disease Division (TA, MA, EM), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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11
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Johnson P, Ammar H. Nocardia brasiliensis vertebral osteomyelitis and epidural abscess. BMJ Case Rep 2013; 2013:bcr-2012-008400. [PMID: 23585503 DOI: 10.1136/bcr-2012-008400] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Nocardia species exist in the environment as a saprophyte; it is found worldwide in soil and decaying plant matter. They often infect patients with underlying immune compromise, pulmonary disease or history of trauma or surgery. The diagnosis of nocardiosis can be easily missed as it mimics many other granulomatous and neoplastic disease. We report a 69-year-old man who presented with chronic back pain and paraparesis. He was found to have Nocardial brasiliensis vertebral osteomyelitis and epidural abscess. Laminectomy and epidural wash out was performed but with no neurological recovery. This is the second reported case of N brasiliensis vertebral osteomyelitis in the literature.
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Affiliation(s)
- Philip Johnson
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
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12
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Clark NM, Reid GE. Nocardia infections in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:83-92. [PMID: 23465002 DOI: 10.1111/ajt.12102] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- N M Clark
- Division of Infectious Diseases, Department of Medicine, Loyola University Stritch School of Medicine, Maywood, IL, USA.
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13
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Iwasaki M, Yano S, Aoyama T, Hida K, Iwasaki Y. Acute onset intramedullary spinal cord abscess with spinal artery occlusion: a case report and review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20 Suppl 2:S294-301. [PMID: 21308472 DOI: 10.1007/s00586-011-1703-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 11/30/2010] [Accepted: 01/23/2011] [Indexed: 11/29/2022]
Abstract
Intramedullary spinal cord abscess (ISCA) without meningitis is an extremely rare entity in the central nervous system, and it is often difficult to diagnose immediately, and no definitive imaging findings have been established. We experienced the case of a 61-year-old male who presented with a sudden onset back pain without fever following rapidly worsening paraparesis for 3 days, who subsequently become unable to walk. According to the initial MRI and 3D-CTA, the presumptive diagnosis was spinal infarction due to spinal artery embolism. However, his symptoms did not improve, despite the gradual changes in MRI following antiplatelet therapy. He underwent a biopsy in an attempt to prevent the lesion from progressing toward the upper spinal cord. The pathological examination revealed an intramedullary abscess, so we performed a midline myelotomy and drained the pus from the abscess. After surgery, MRI showed improvement, but the patient's paraplegia persisted. To the best of our knowledge, this is the first case report of spinal cord abscess with the confirmation of spinal artery occlusion on angiography, which could have been caused by a bacterial embolism. We herein discuss its possible etiology and also review recent reports on ISCA.
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Affiliation(s)
- Motoyuki Iwasaki
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo 060-8638, Japan.
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14
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Paul AEH, Mansfield CS, Thompson M. Presumptive Nocardia spp. infection in a dog treated with cyclosporin and ketoconazole. N Z Vet J 2010; 58:265-8. [PMID: 20927178 DOI: 10.1080/00480169.2010.69301] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
CASE HISTORY A dog that had received 8 months of cyclosporin and ketoconazole therapy for treatment of atopic dermatitis subsequently developed severe neurological disease, that failed to respond to treatment with trimethoprim-sulphadiazine and clindamycin. HISTOPATHOLOGICAL FINDINGS: Histopathological examination of the pulmonary parenchyma and spinal cord revealed loose aggregates of Gram-positive, partially acid-fast, fine, beaded, filamentous bacteria, most consistent with Nocardia spp. DIAGNOSIS A presumptive diagnosis was made of disseminated nocardiosis of the spinal cord and lungs. CLINICAL RELEVANCE Nocardia spp. is an opportunistic actinomycete that may cause disseminated disease, particularly in immunocompromised animals. Cyclosporin is used in veterinary medicine to control immune-mediated and allergic disorders, with few reported adverse side effects. This case gives further evidence that involvement of the spinal cord in nocardiosis of the central nervous system (CNS) carries a poor prognosis, and opportunistic infection by Nocardia spp. may be a potential complication of immunosuppressive cyclosporin therapy in the dog.
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Affiliation(s)
- A E H Paul
- Department of Veterinary Clinical Sciences, Murdoch University, Murdoch, Western Australia 6150, Australia.
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15
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Mishra S, Ghazarian D, Lutynski A, Minden MD, Bartlett ES, Rotstein C. Malignant mimicry. Am J Med 2010; 123:697-700. [PMID: 20670720 DOI: 10.1016/j.amjmed.2010.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 04/20/2010] [Accepted: 04/20/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Sharmistha Mishra
- Division of Infectious Diseases, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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16
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Frank M, Woschnagg H, Mölzer G, Finsterer J. Cerebellar nocardiosis and myopathy from long-term corticosteroids for idiopathic thrombocytopenia. Yonsei Med J 2010; 51:131-7. [PMID: 20046527 PMCID: PMC2799960 DOI: 10.3349/ymj.2010.51.1.131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 05/09/2008] [Accepted: 05/14/2008] [Indexed: 11/30/2022] Open
Abstract
Infection of the central nervous system with Nocardia sp. usually manifests as supratentorial abscesses. Supratentorial and cerebellar abscesses from infection with Nocardia sp. following immunosuppression with long-term corticosteroids for idiopathic thrombocytopenia (ITP) have not been reported. An 83 years-old, human immunodeficiency virus (HIV)-negative, polymorbid male with ITP for which he required corticosteroids since age 53 years developed tiredness, dyspnoea, hemoptysis, abdominal pain, and progressive gait disturbance. Imaging studies of the lung revealed an enhancing tumour in the right upper lobe with central and peripheral necrosis, multiple irregularly contoured hyperdensities over both lungs, and right-sided pleural effusions. Sputum culture grew Nocardia sp. Neurological diagnostic work-up revealed dysarthria, dysphagia, ptosis, hypoacusis, tremor, dysdiadochokinesia, proximal weakness of the lower limbs, diffuse wasting, and stocking-type sensory disturbances. The neurological deficits were attributed to an abscess in the upper cerebellar vermis, myopathy from corticosteroids, and polyneuropathy. Meropenem for 37 days and trimethoprime-sulfamethoxazole for 3 months resulted in a reduction of the pulmonary, but not the cerebral lesions. Therefore, sultamicillin was begun, but without success. Long-term therapy with corticosteroids for ITP may induce not only steroid myopathy but also immune-incompetence with the development of pulmonary and cerebral nocardiosis. Cerebral nocardiosis may not sufficiently respond to long-term antibiotic therapy why switching to alternative antibiotics or surgery may be necessary.
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Affiliation(s)
- N M Clark
- University of Illinois at Chicago, Section of Infectious Diseases, Chicago, IL, USA.
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Abcès cérébraux à Nocardia : caractéristiques radiocliniques et prise en charge thérapeutique. Rev Neurol (Paris) 2009; 165:52-62. [DOI: 10.1016/j.neurol.2008.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 06/05/2008] [Accepted: 06/20/2008] [Indexed: 11/24/2022]
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KURITA N, SAKURAI Y, TANIGUCHI M, TERAO T, TAKAHASHI H, MANNEN T. Intramedullary Spinal Cord Abscess Treated With Antibiotic Therapy -Case Report and Review-. Neurol Med Chir (Tokyo) 2009; 49:262-8. [DOI: 10.2176/nmc.49.262] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Makoto TANIGUCHI
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital
| | - Toru TERAO
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital
| | - Hiroshi TAKAHASHI
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital
| | - Toru MANNEN
- Department of Neurology, Mitsui Memorial Hospital
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20
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Aboal C, Salamano R, Braselli A, Mansilla M, Galaret M, Pedreira W. Absceso recidivante por Nocardia asteroides en una paciente portadora de poliglobulia primaria. ARQUIVOS DE NEURO-PSIQUIATRIA 2006; 64:526-9. [PMID: 16917633 DOI: 10.1590/s0004-282x2006000300034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Accepted: 02/24/2006] [Indexed: 11/21/2022]
Abstract
La nocardiosis del sistema nervioso central (SNC) es una enfermedad poco común, cuya frecuencia ha aumentado con el crecimiento de los tratamientos inmunosupresores. El hombre se infecta por inhalación, inoculación traumática cutánea directa y tras una infección periodontal ingiriendo alimentos contaminados. La localización pulmonar es la más frecuente, siendo la fuente inicial de diseminación hemática, con predominio en piel, tejido celular subcutáneo y SNC. Es conocida la predilección de Nocardia por el SNC. Estos abscesos, asociados a altos índices de mortalidad, especialmente en pacientes inmunocomprometidos, siguen constituyendo un desafío diagnóstico y terapéutico, permaneciendo no aclarado su manejo terapéutico óptimo. A pesar de la controversia en cuanto al manejo quirúrgico de estas lesiones, el diagnóstico precoz, por aspiración esterotáxica, y la iniciación de una terapia antimicrobiana son esenciales para la buena evolución del paciente. Se presenta una paciente portadora de una poliglobulia primaria, con absceso cerebral recidivante por Nocardia asteroides de posible origen dentario.
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Affiliation(s)
- Carlos Aboal
- Instituto de Neurología, Facultad de Medicina, Hospital de Clinicas Dr. Manual Quintela, Avenida Italia s/n, Montevideo 11600, Uruguay.
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Atalay B, Azap O, Cekinmez M, Caner H, Haberal M. Nocardial epidural abscess of the thoracic spinal cord and review of the literature. J Infect Chemother 2005; 11:169-71. [PMID: 15990983 DOI: 10.1007/s10156-005-0384-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2004] [Accepted: 04/20/2005] [Indexed: 10/25/2022]
Abstract
Nocardia is a potential cause of opportunistic infection in organ-transplant recipients. We report an epidural abscess causing acute paraparesis in a patient with a rejected renal transplant and chronic liver disease. Early drainage and treatment with imipenem and trimethoprim-sulfamethoxasole improved the patient's neurologic status.
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Affiliation(s)
- Basar Atalay
- Baskent University Department of Neurosurgery, Ankara, Turkey.
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22
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Tali ET, Gültekin S. Spinal infections. Eur Radiol 2004; 15:599-607. [PMID: 15627186 DOI: 10.1007/s00330-004-2576-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2004] [Revised: 11/02/2004] [Accepted: 11/04/2004] [Indexed: 10/25/2022]
Abstract
Spinal infections have an increasing prevalence among the general population. Definitive diagnosis based solely on clinical grounds is usually not possible and radiological imaging is used in almost all patients. The primary aim of the authors is to present an overview of spinal infections located in epidural, intradural and intramedullary compartments and to provide diagnostic clues regarding different imaging modalities, particularly MRI, to the practicing physicians and radiologists.
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Affiliation(s)
- E Turgut Tali
- Department of Radiology, Division of Neuroradiology, Gazi University School of Medicine, Besevler, Ankara, 06510, Turkey.
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Malincarne L, Marroni M, Farina C, Camanni G, Valente M, Belfiori B, Fiorucci S, Floridi P, Cardaccia A, Stagni G. Primary brain abscess with Nocardia farcinica in an immunocompetent patient. Clin Neurol Neurosurg 2002; 104:132-5. [PMID: 11932043 DOI: 10.1016/s0303-8467(01)00201-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In this paper, we describe a case of an immunocompetent patient with cerebral nocardiosis. The onset was with loss of strength, paresthesia and focal epilepsy of the left arm. MRI showed on T2-weighted sequences a hyperintense central area of pus surrounded by a well-defined hypointense capsule and surrounding edema; on T1-weighted sequences a hypointense necrotic cavity with ring enhancement following administration of intravenous gadolinium. The patient underwent surgical excision of the abscess but culture from the specimen was negative. After 40 days of empirical antimicrobial therapy he developed neurological deterioration with focal epilepsy. A new MRI documented an enlargement of the hypointense lesion in the right frontal-parietal region. A second craniotomy with drainage of the abscess was performed; cultures yielded Nocardia farcinica. Therapy with trimethoprim/sulfamethoxazole, amikacin and meropenem was given for 35 days, and clinical and radiological improvement was observed. Home therapy was done with oral trimethoprim/sulfamethoxazole. Currently, 5 months from the second surgery, the patient can walk with support and no new episodes of epilepsy occurred. Side effects were absent from therapy. The MRI appearance of the brain lesion has improved, with a decrease in size, surrounding edema and ring enhancement.
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Affiliation(s)
- Lisa Malincarne
- Department of Experimental Medicine and Biochemical Science, Section of Infectious Diseases, University of Perugia, Perugia, Italy
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