Objective To analyze the clinical features,diagnosis and treatment of Nocardia farcinica infection involving central nervous system in order to improve awareness and precise antimicrobial treatment of the disease.Methods We reported a case of multiple brain abscesses caused by N.farcinica infection treated in the Department of Infectious Diseases,Beijing Tsinghua Changgung Hospital.PubMed database was searched using key term"Nocardia farcinica"to retrieve relevant articles published in English during the period from January 1,1967 to September 18,2022.A total of 433 English articles were retrieved.Wanfang database and VIP database were also searched using"Nocardia farcinica"in Chinese as keywords to retrieve relevant articles published in Chinese from October 1,1999 to September 18,2022.A total of 153 articles were retrieved.The clinical data of 70 cases of N.farcinica central nervous system infection were collected and analyzed.Results The patient in our center was admitted with headache and disturbance of consciousness.After admission,N.farcinica was detected from cerebrospinal fluid by mNGS.The treatment included trimethoprim-sulfamethoxazole(TMP-SMZ)combined with meropenem,moxifloxacin and amikacin.The lesions were absorbed after 1 month of treatment.TMP-SMZ and moxifloxacin were taken orally after discharge from hospital.The total treatment duration was 1 year.Among the 70 patients with N.farcinica CNS infection,51(72.8％)were males,with an average age of 58.6±15.3 years.Prior glucocorticoid use was found in 57.1％of the patients and involvement of other body site in 57.1％of the patients.The diagnosis was based on traditional bacterial culture in 80.0％(56/70)of the patients,by polymerase chain reaction or mNGS in the remaining patients(20.0％,14/70).TMP-SMZ was the main antimicrobial agent for N.farcinica CNS infection,which was used in 85.7％of the patients.The overall mortality rate was 24.2％.Conclusions The central nervous system infection caused by N.farcinica is characterized by fever,limb movement disorder and headache.It is readily to disseminate to other body sites in addition to central nervous system involvement.The diagnosis and treatment are relatively difficult associated with high mortality rate because the clinical manifestations of this disease are nonspecific.A variety of testing methods,including mNGS,are available for confirming the etiological diagnosis as soon as possible.
关键词
诺卡菌病/皮疽诺卡菌/中枢神经系统感染/脑脓肿/宏基因组二代测序
Key words
nocardiosis/Nocardia farcinica/central nervous system infection/brain abscess/metagenomics next-generation sequencing
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