Université de Paris.
Service de Microbiologie, Unité Mobile d'Infectiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.
Curr Opin Infect Dis. 2021 Dec 1;34(6):611-618. doi: 10.1097/QCO.0000000000000782.
Brain nocardiosis is a rare but severe infection mostly occurring among immunocompromised patients. In this review, we present recent data on this infection and address some of the common clinical dilemmas encountered in patients with brain nocardiosis.
Strategies used to approach a patient with suspected brain nocardiosis include the 'conservative strategy' (without early neurosurgery) and the 'neurosurgical strategy' (with early aspiration or excision of brain abscess[es]). The advantages and disadvantages of both strategies are summarised. Our opinion is that the use of the 'conservative strategy' should be limited to well-selected patients presenting with an easily accessible extra-neurological lesion(s) and have brain abscesses at low risk of treatment failure. In terms of antimicrobial therapy, we summarise the data supporting the use of a multidrug regimen in patients with brain nocardiosis.Last, we list possible reasons for treatment failure in patients with brain nocardiosis and suggest interventions to overcome them.
Literature is scarce regarding brain nocardiosis, as a consequence of the rarity of this disease. A multidisciplinary and individualised management is required to optimise the outcome of patients with brain nocardiosis.
脑诺卡菌病是一种罕见但严重的感染，主要发生在免疫功能低下的患者中。在这篇综述中，我们介绍了关于这种感染的最新数据，并探讨了脑诺卡菌病患者中常见的一些临床难题。
对疑似脑诺卡菌病患者的处理策略包括“保守策略”（不进行早期神经外科手术）和“神经外科策略”（早期抽吸或切除脑脓肿）。总结了这两种策略的优缺点。我们认为，“保守策略”的使用应仅限于精心选择的、具有易于接近的非神经病变和脑脓肿风险低的患者。在抗菌药物治疗方面，我们总结了支持在脑诺卡菌病患者中使用多药物方案的数据。最后，我们列出了脑诺卡菌病患者治疗失败的可能原因，并提出了克服这些原因的干预措施。
由于这种疾病罕见，文献中关于脑诺卡菌病的内容很少。需要多学科和个体化的管理，以优化脑诺卡菌病患者的治疗效果。
