Anagnostou Theodora, Arvanitis Marios, Kourkoumpetis Themistoklis K, Desalermos Athanasios, Carneiro Herman A, Mylonakis Eleftherios
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.
Medicine (Baltimore). 2014 Jan;93(1):19-32. doi: 10.1097/MD.0000000000000012.
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.
中枢神经系统诺卡菌病是一种由诺卡菌属丝状细菌引起的罕见疾病实体。我们展示了我院5例患者的病例系列，并对2000年1月至2011年12月文献报道的中枢神经系统诺卡菌病病例进行了综述。我们的结果表明，中枢神经系统诺卡菌病可发生于免疫功能低下和免疫功能正常的个体，可能是先前肺部感染的结果，也可能独立存在。最常见的诱发因素是使用皮质类固醇（54%的患者）和器官移植（25%）。该病的表现差异很大，现有的诊断测试远非完美，常常导致检测和治疗的延迟。最佳治疗方法仍未确定，取决于菌种，但据报道，联合使用包括甲氧苄啶/磺胺甲恶唑（TMP-SMX）在内的靶向抗菌治疗6个月以上并进行神经外科干预，可降低死亡率和复发率。
