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Nocardia is an uncommon cause of human disease. We report a patient with a fatal brain abscess who had abnormal phagocyte function as measured by neutrophile chemotaxis, adherence, phagocytic function, and chemiluminescence in vitro and by Rebuck skin window in vivo. Antimicrobial agar dilution susceptibility suggested minocycline was more active than sulfamethoxazole.
Oropharyngeal foreign bodies are not infrequently encountered in dogs and are usually associated with dysphagia. In this case an oropharyngeal foreign body resulted in nervous signs as a result of penetration of the cranial cavity and the development of a brain abscess.
Burkholderia pseudomallei is an important human pathogen in tropical areas, particularly South East Asia and Northern Australia. A fatal case of meliodosis presenting as brain abscesses is described. The patient deteriorated despite treatment and died 21 days after admission. Burkholderia pseudomallei was only isolated after administration of corticosteroids, whilst on treatment with antibiotics to which the organism later showed in vitro sensitivity. Magnetic resonance imaging was more sensitive than computed tomography in diagnosing early brainstem infection in this patient. Physicians working outside the endemic areas must be attuned to the possibility of melioidosis in any patient with an appropriate history of travel to endemic areas. The combination of striking early, extensive, confluent T2 hyperintensity with disproportionately small enhancing lesions may be characteristic of meliodosis.
A new sonographic contrast agent, gelatin-encapsulated nitrogen microbubbles, was introduced intraarterially to enhance the high-resolution sonographic scan of an experimental brain abscess. The echogenicity produced by the microbubbles correlated closely to the site and distribution of abscess neovascularity. The contrast agent aided in the detection of small necrotic centers in the late stages of abscess evolution when these centers were not visualized on noncontrast sonograms. The echogenic effect of the microbubbles was maximum immediately after injection; it decreased by 5 min and had virtually disappeared at 15 min.
INTRODUCTION: Nocardiosis is a rare, generally systemic infection that occurs in immunocompromised patients. We report a case of Nocardia farcinica primary brain abscess in an immunocompetent patient, unusually associated with a pulmonary embolism. OBSERVATION: A 62 year-old woman without medical past was hospitalised because of a Bravais-Jacksonian type of seizure. The clinical and radiological profile was unspecific. The diagnosis was made on identification of the microorganism. The patient improved after craniotomy with excision of the abscess and appropriate antibiotic therapy for four months. DISCUSSION: The N. farcinica species is distinct from others by its high degree of antibiotic resistance its virulence. We insist on the need to identify not only the microorganism but also the species concerned because this may influence the treatment strategy.
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We report a premature infant with Staphylococcus aureus sepsis, most probably originating from an infected peripheral iv site, and complicated by multiple brain abscesses. Diagnosis was made by cranial ultrasonography and computed tomography. Since systemic antibiotic treatment failed, surgical drainage was performed. The same organism that caused the initial sepsis grew from the pyogenic material obtained. The child is currently severely handicapped.
A 32-year-old female with alcoholic cirrhosis attempted to drown herself in a pond. She remained in a coma for 57 days. After a stormy course she developed multiple brain abscesses due to Scedosporium (Monosporium) apiospermum. Despite intravenous and intrathecal amphotericin B (total dose 870 mg) the patient died 71 days after the near drowning.
A 39-year-old healthy man developed a brain abscess weeks after a near-drowning incident. Scedosporium apiospermum, the anamorph of Pseudallescheria boydii, was isolated from the abscess. The patient died 153 days after the accident despite antifungal therapy. We discuss the role of antifungals and review the literature for comparable cases.
Patients with pulmonary arteriovenous fistulas (PAVFs) are at risk for the development of brain abscesses. The history of a 26-year-old man with PAVF, which has remained unrecognized for many years, is reported. Within four years, the patient presented life threatening cerebral abscesses twice at different sites. Treatment consisted of parenteral antibiotics. Finally, the pulmonary arteriovenous fistula has been treated by embolization. This case emphasizes the importance of early diagnosis and treatment of PAVF in preventing central nervous system infections. Copyright 1998 Lippincott Williams & Wilkins