Nocardia farcinica as the Causative Agent of a Brain Abscess in a Patient with Interstitial Lung Disease
Authors:
J. Scharfen jr. 1,2; M. Morávková 2; M. Bunček 3; V. Hobza 4; S. Plíšek 5; P. Urbášková 6; I. Sedláček 7; H. Žemličková 6,8; H. Stárková 1; P. Paterová 2
Authors‘ workplace:
Národní referenční laboratoř pro patogenní aktinomycety, Oddělení lékařské mikrobiologie a imunologie, Oblastní nemocnice Trutnov, a. s.
1; Ústav klinické mikrobiologie LF UK v Hradci Králové a FN, Hradec Králové
2; Generi Biotech, a. s., Hradec Králové
3; Neurochirugická klinika LF UK v Hradci Králové a FN, Hradec Králové
4; Infekční klinika LF UK v Hradci Králové a FN, Hradec Králové
5; Národní referenční laboratoř pro antibiotika, Státní zdravotní ústav v Praze
6; Česká sbírka mikroorganismů Přírodovědecké fakulty Masarykovy University v Brně
7; Národní sbírka typových kultur, Státní zdravotní ústav Praha
8
Published in:
Epidemiol. Mikrobiol. Imunol. 59, 2010, č. 1, s. 13-20
Overview
This case report describes a two-step protocol for the identification of the causative agent of nocardiosis in a patient with brain abscess, antibiotic susceptibility testing and etiological treatment after neurosurgery. The patient treated with corticosteroids for pulmonary fibrosis and presenting with multiple neurological manifestations was admitted to a neurosurgery clinic. CT and contrast MRI revealed an expansive multilocular lesion 45 x 35 mm in size in the left parietal lobe, differentially diagnosed as malignant glioma. The lesion was biopsied and the histology showed a brain abscess containing white blood cells and dead tissue. The aspirated pus culture yielded bacteria of the genus Nocardia that were further identified, in the first step, by phenotypic methods (Gram positivity, partial acidoresistance, airborne mycelium detection, growth at 45 °C, lysozyme resistance and antibiotic resistance phenotype) as belonging to resistance phenotype V., v.s. N. farcinica (resistance to aminoglycosides except amikacin and to third-generation cephalosporins). In the second step of the polyphasic identification, rDNA was isolated and a 1000 bp part of the 16S rRNA gene was sequenced. Sequence comparison with the GenBank database using BLAST software identified the agent as N. farcinica (100%). The isolate was tested for susceptibility by the NCCLS /CLSI dilution method and showed good susceptibility to co-trimoxazole, amikacin and imipenem. The patient was treated with long-term intravenous cotrimoxazole acid in combination with amikacin and his clinical condition and laboratory parameters of inflammation improved. N. farcinica is among the three most frequently isolated Nocardia species in Europe as well as in the Czech Republic where it was repeatedly recovered from the lungs and respiratory tract of immunocompromised patients with systemic nocardiosis.
Key words:
Nocardia farcinica – brain abscess – polyphasic identification – 16S rRNA – resistance phenotype.
Sources
1. Boiron, P., Provost, F., Dupont, B. Laboratory methods for the diagnosis of nocardiosis. 1st Ed., Institut Pasteur, Paris, 1993.
2. Borchers, M., von der Mülbe, B., Teikemeier, F., Theegarten, D. Pulmonary nocardiasis with abscesses spreading to cerebrum, cerebellum and orbits. Article in German. Dtsch. Med. Wochenschr. 2006, 131,19,1085-8
3. Brown, B. A., Wallace, Jr., R. J. Broth microdilution MIC test for Nocardia spp., 5.12.1–5.12.9. In H. D. Isenberg (ed.), Clinical microbiology procedures handbook. American Society for Microbiology, Washington,D.C.1992.
4. Brown, J.M., McNeil,M.M. Nocardia, Rhodococcus, Gordonia, Actinomadura, Streptomyces, and other aerobic actinomycetes, pp. 370–398. In P. R. Murray, E. J. Baron, J. H. Jorgensen, M. A. Pfaller, R. H. Yolken (ed.), Manual of clinical microbiology, 8th ed. ASM Press, Washington,D.C, 2003.
5. Brown-Elliott, B.A., Brown, J.M., Conville, P.S., Wallace, R.J. jr. Clinical and laboratory features of the Nocardia spp., based on current molecular taxonomy. Clin. Microbiol. Rev. 2006; 19, 2, 259-282.
6. Conville, P.S, Witebsky, F.G. Nocardia, Rhodococcus, Gordonia, Actinomadura, Streptomyces, and Other Aerobic Actinomycetes, pp. 515–541. In P. R. Murray, E. J. Baron, J. H. Jorgensen, M.L.Landry, M. A. Pfaller (ed.), Manual of clinical microbiology, 9th ed. ASM Press, Washington, 2007
7. Djennane, S., Zecknini, K., Billy, C., Kamga, I., Perronne, V., Granier, F. Nocardia farcinica brain abscess associated with a pulmonary embolism in an immunocompetent patient. Presse Med. 2005, 34, 7, 522-4.
8. Fellows, G.A., Kalsi, P.S., Martin, A.J. Nocardia farcinica brain abscess in a patient without immunocompromised. Br. J. Neurosurg. 2007, 3, 301-3
9. Hope, W., Looke, D. Sequential infection with Nocardia farcinica and Cryptococcus neoformans var. gattii in an immunocompetent host. J. Infect. 2003, 47, 256-9.
10. Iannotti, C.A., Hall, G.S., Procop, G.W., Tuohy, M.J., Staugaitis, S.M., Weil, R.J. Solitary Nocardia farcinica brain abscess in an immunocompetent adult mimicking metastatic brain tumor: rapid diagnosis by pyrosequencing and successful treatment. Surg. Neurol. 2008, May 29. [Epub ahead of print]
11. Jorgensen, J.H., Turnidge, J.D. Susceptibility test methods: Dilution and disc diffusion methods pp.1113-1115.. In Murray PR, et.al (eds). Manual of Clinical Microbiology, 8th ed. ASM, Washington 2003;
12. Kandasamy, J., Kabal, H.J., Cooke, R.P., Eldridge, P.R. Primary Nocardia farcinica brain abscess with secondary meningitis and ventriculitis in an immunocompetent patient, successfully treated with moxifloxacin. Acta Neurochir. (Wien). 2008; 150, 5, 505-6.
13. Kilincer, C., Hamamcioglu, M.K., Simek, O., Hicdonmez, T., Aydoslu, B., Tansel, O., Tiryaki, M., Soy, M., Tatman-Otkun, M., Cobanoglu, S. Nocardial brain abscess: review of clinical management. J. Clin. Neurosci. 2006, 13,4, 481-5.
14. Kostur, M., Storey, D. Nocardia farcinica osteomyelitis of the frontal bone five years after Nocardia brain abscess in an immunocompetent patient. J. Miss. State Med. Assoc. 2002 43,4,111.
15. Malincarne, L., Martini, 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. 2002,104,2,132-5.
16. McNeil, M. M., Brown, J. The medically important aerobic actinomycetes: epidemiology and microbiology. Clin. Microbiol. Rev. 1994, 7 357–417.
17. Mellmann, A., Cloud, J.L., Andrees, S. et al. Evaluation of RIDOM, MicroSeq an GenBank services in the molecular identification of Nocardia species. Int. J. Med. Microbiol. 2003; 293, 359-370.
18. NCCLS. Susceptibility testing of mycobacteria, nocardiae, and other aerobic actinomycetes. Approved standard. NCCLS document M24-A. NCCLS, Wayne, Pa, 2003.
19. Sabuncuo’lu, H., Cibali Aćikgo, Z.Z., Caydere, M., Ustün, H., Semih Keskil, I. Nocardia farcinica brain abscess: a case report and review of the literature. Neurocirugia (Astur). 2004, 6, 600-3
20. Scharfen, J. jr. Doporučená metoda k předběžné identifikaci nokardií podle fenotypu rezistence (Recommended method for preliminary identification of Nocardia spp. according to antimicrobial susceptibility pattern), Zprávy CEM ,SZÚ Praha, 2007; 3,16
21. Scharfen, J. jr. Nokardióza. Doporučená metoda mikrobiologické diagnostiky nokardiózy s přehledem léčby nokardiózy a návrhem standardního operačního postupu. NUCLEUS Hradec Králové, 2008. ISBN 978-80-87009-43-7
22. Singh, N.P., Goral, R., Manchanda, V., Gusta, P. Disseminated nocardiosis in an immunocompetent child. Ann. Trop. Paediatr. 2003,23,1,75-8
23. Sorrell, T.C. et al: Nocardia species, pp.2916-2924 In Mandell, Douglas and Bennettęs Principles and Practice of Infectious Diseases, 6th ed, Elsevier, 2005
24. Urbášková P. Rezistence bakterií k antibiotikům. Vybrané metody. Trios 1998.
25. van Dam, A.P., Pruijm, M.T., Harinck, B.I., Gelinck, L.B., Kuijper, E.J. Pneumonia involving Aspergillus and Rhizopus spp. after a near-drowning incident with subsequent Nocardia cyriacigeorgici and N. farcinica coinfection as a late complication. Eur. J. Clin. Microbiol. Infect. Dis. 2005, 24, 1,61-4
26. Wallace, R.J. jr., Tsukamura, M., Brown, A.B., et al. Cefotaxime-resistant Nocardia asteroides strains are isolates of the controversial species Nocardia farcinica. J. Clin. Microbiol. 1990, 28,12,2726-2732.
27. Wauters, G., Avesani, V., Charlier, J. et al.: Distribution of Nocardia species in clinical samples and their routine rapid identification in the laboratory. J. Clin. Microbiol. 2005, 43, 6, 2624 -2628.
Labels
Hygiene and epidemiology Medical virology Clinical microbiologyArticle was published in
Epidemiology, Microbiology, Immunology
2010 Issue 1
Most read in this issue
- The Incidence of Tularemia in Slovakia in 1997-2008
- Nocardia farcinica as the Causative Agent of a Brain Abscess in a Patient with Interstitial Lung Disease
- Exotic Pets as a Potential Source of Salmonella
- Geography of the HIV/AIDS Pandemic: Analysis of Selected Available Papers and Studies