Purpose Of Review: 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.
Recent Findings: 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.
Summary: 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.
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Article Synopsis
- - This systematic review analyzes 512 cases of Nocardia brain infections from 2000 to mid-2024, focusing on clinical symptoms, imaging results, and antibiotic resistance patterns in both immunocompromised and non-immunocompromised patients.
- - It highlights the shortcomings of traditional microbiological cultures in diagnosing these infections compared to advanced molecular methods, which improve detection speed and accuracy.
- - Key factors for better treatment outcomes include timely antibiotic administration (notably sulfonamides and β-lactams) and the potential need for surgical intervention, emphasizing the importance of improved diagnostic and treatment strategies.
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