Twenty-two cases of nocardial infections were diagnosed in our city between 1977- 1998. All patients whose clinical specimens showed Nocardia spp. at Gram stain, which were further confirmed by culture, were selected to be included in the study. Data from patients who were cured were compared with those from patients who died by statistical tests using EPIINFO version 6.04 software. Six isolates were identified as Nocardia asteroides complex, one as Nocardia asteroides sensu stricto and other as Nocardia brasiliensis. We had 17 cases of lung nocardiosis, being one out of them also a systemic disease. Other four cases of systemic nocardiosis were diagnosed: nocardial brain abscesses (one); nocardiosis of the jejunum (one); multiple cutaneous abscesses (one); and a case of infective nocardial endocarditis of prosthetic aortic valve. One patient had a mycetoma by N. brasiliensis. Fifteen (68.2%) out of 22 patients were immunosuppressed, being most (93.3%) by high-doses corticotherapy. Mortality by nocardial infection was 41%; mortality of systemic nocardiosis was 60%. Nocardiosis has a bad prognosis in immunosuppressed patients and also in non-immunosuppressed patients if the diagnosis is delayed. We propose that the delay in diagnosis should be examined in larger series to document its influence in the prognosis of the disease. (+info)
Clinical and laboratory findings in neurobrucellosis: review of 31 cases.
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BACKGROUND: Neurobrucellosis is an uncommon complication of brucellosis. The clinical features of neurobrucellosis vary greatly and, in general, tend to be chronic. Many of the laboratory procedures usually employed in the diagnosis of brucellosis frequently give negative results. For these reasons, and because brucellosis is a disease, which is both treatable and curable, the degree of suspicion must be high, especially in endemic areas, so that an early diagnosis can be made to allow suitable treatment to be established. METHODS: A retrospective analysis of 31 cases of neurobrucellosis was carried out. RESULTS: Meningitis and meningoencephalitis were the most common form of neurobrucellosis in our patients. The most commonly-used antibiotics were combinations of rifampin, doxycycline, and trimethoprim-sulfamethoxazole. CONCLUSION: The differential diagnosis of neurobrucellosis is wide. However, the disease should be ruled out in all patients who develop unexplained neurological symptoms, especially in those who live in endemic areas. (+info)
Management of neurobrucellosis: an assessment of 11 cases.
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OBJECTIVE: The central nervous system involvement of Brucellosis causes a hard to treat infection with multiple sequelae. The aim of this paper is to discuss the course of neurobrucellosis in response to therapy. PATIENTS AND METHODS: Patients with neurobrucellosis were evaluated. The diagnosis was established by the isolation of bacteria, abnormal CSF findings and positive serology. Ceftriaxone, rifampicin, doxycycline and trimethoprim sulfamethoxazole were the antibiotic choices for these cases. RESULTS: We present 11 cases with neurobrucellosis. None of our patients died, albeit one case has a critical situation due to subarachnoid hemorrhage and its' concordant sequelae. Only one of four patients with walking difficulty and two with hearing loss were normalized with therapy. Imaging techniques did not provide any specific contribution regarding the Brucella infection. CONCLUSIONS: Parenteral ceftriaxone should be used as an initial alternative in the management of neurobrucellosis. Although the therapy should be individualized, the duration of therapy should be a minimum of six months with suitable antibiotics. (+info)
Rapid eradication of Listeria monocytogenes by moxifloxacin in a murine model of central nervous system listeriosis.
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Legionnaires' disease with hypoperfusion in the cerebellum and frontal lobe on single photon emission computed tomography.
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A 59-year-old man was admitted for further investigation of headache. Neurological examination revealed memory loss, disorientation, and bilateral intention tremor. Legionella pneumophila antigen was detected in the urine. Brain magnetic resonance diffusion-weighted images showed marked hyperintensity in the splenium of the corpus callosum without other abnormalities. Single photon emission CT with Tc-99m hexamethyl-propyleneamine oxime showed multi-focal hypoperfusion in the brain, involving mainly the cerebellum and frontal lobe. This is the first report demonstrating cerebellar and frontal lobe hypoperfusion without corresponding MRI abnormalities in a patient with central nervous system Legionnaires' disease. (+info)
Probable cerebral Mycobacterium avium complex-related immune reconstitution inflammatory syndrome in an HIV-infected patient.
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The advent of highly active anti-retroviral therapy (HAART) has reduced both the morbidity and incidence of acquired immunodeficiency syndrome (AIDS)-related central nervous system (CNS) diseases. However, some patients seem to suffer paradoxical clinical deterioration after starting HAART, known as immune reconstitution inflammatory syndrome (IRIS). We report a rare case of probable Mycobacterium avium complex (MAC) infection of the brain in a patient with AIDS who had been treated effectively for probable pulmonary and cerebral MAC infection, with both lesions recurring after significant decreases in plasma human immunodeficiency virus type-1 viral load following initiation of HAART. This case appears to represent the first precise clinicopathological description of severe ventriculo-encephalitis in CNS MAC-related IRIS. (+info)
Application of molecular tools for the diagnosis of central nervous system infections.
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