Affiliated Eye Hospital of Nanchang University, 463 Bayi Road, Nanchang, 330000, Jiangxi, China.
BMC Infect Dis. 2019 Nov 8;19(1):953. doi: 10.1186/s12879-019-4605-z.
Localized `and disseminated Nocardia farcinica infection is frequently reported in immunocompromised patients. However, orbital nocardiosis is rare, and, to our knowledge, traumatic orbital nocardiosis that affects the brain has never been described. Here, we report a case of traumatic orbital and intracranial N. farcinica infection in an immunocompetent patient.
A 35-year-old man, who was immunocompetent, to the best of our knowledge and as per the absence of immunodeficiency symptoms, with orbital trauma caused by the penetration of a rotten bamboo branch developed lesions in the orbit and brain. Subsequently, he underwent debridement and received broad-spectrum antibiotic therapy, but orbital infection occurred, with drainage of pus through the sinus tract. The patient then underwent endoscope-assisted local debridement. Bacterial culture of the sinusal pus was positive for N. farcinica, and a combined intracranial infection had developed. The disease was treated effectively by trimethoprim-sulfamethoxazole and ceftriaxone sodium therapy. The patient remained infection free and without complications at the 14-month follow-up.
Traumatic orbital and intracranial infection caused by N. farcinica is a rare infectious disease, and atypical presentations easily lead to misdiagnosis. When a patient presents with an atypical orbital infection that is unresponsive to empirical broad-spectrum antibiotics, along with suspicious neurologic symptoms, Nocardia infection should be considered. Identification by bacterial culture is the gold standard. Complete local debridement and appropriate antibiotic treatment are keys to the treatment of the disease.
局限性和播散性诺卡氏菌感染在免疫功能低下的患者中经常报道。然而，眼眶诺卡菌病很少见，据我们所知，影响大脑的外伤性眼眶诺卡菌病从未被描述过。在这里，我们报告了一例免疫功能正常的患者发生外伤性眼眶和颅内诺卡氏菌感染。
一名 35 岁的男性，据我们所知，他的免疫功能正常，没有免疫缺陷症状，由于腐烂的竹枝穿透导致眼眶受伤，出现了眼眶和脑部病变。随后，他接受了清创术和广谱抗生素治疗，但发生了眼眶感染，通过窦道排出脓液。然后，患者接受了内镜辅助局部清创术。窦道脓液的细菌培养阳性为诺卡氏菌，并发颅内感染。该患者经甲氧苄啶-磺胺甲噁唑和头孢曲松钠联合治疗有效。在 14 个月的随访中，患者未再出现感染，也无并发症。
由诺卡氏菌引起的外伤性眼眶和颅内感染是一种罕见的传染病，不典型表现容易导致误诊。当患者出现对经验性广谱抗生素治疗不敏感的非典型眼眶感染，并伴有可疑的神经症状时，应考虑诺卡菌感染。细菌培养是金标准。彻底的局部清创术和适当的抗生素治疗是治疗该病的关键。
