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Meningitis caused by Nocardia asteroides in an immunocompromised patient






Deltion Ellenikes Mikrobiologikes Etaireias 42(2): 243-247, March-April

Meningitis caused by Nocardia asteroides in an immunocompromised patient

We report a case of meningitis caused by Nocardia asteroides in a female patient who was under continuous immunosuppressive therapy and whose underlying disease was chronic autoimmune hepatitis. Prior to admission the patient was under therapy with prednisone and azathioprine. On admission she presented with fever, headache and confusion. Lumbar puncture showed a very elevated cell count with predomination of neutrophils (apprx 27000 mm3) in the CSF, increased total protein and decreased glucose. Filamentous, branching bacteria, partially acid fast by Kinyoun method, were cultured from the CSF and they were identified as Nocardia spp. The patient was treated with meropenem and sulfonamides in combination with trimethoprim. She developed hydrocephalus and she was surgically treated After that her condition is gradually improving but she is still not discharged from the hospital. Norcardial infections occur predominantly in immunocompromised hosts. Organs that are affected are most frequently the lungs and the skin. Central nervous system nocardiosis in the form of cerebral abscesses and/or meningitis is vety rare and it is almost always the result of hematogenous dissemination. Early detection of Nocardia spp. requires good cooperation between clinicians and the laboratory personnel otherwise the microorganism may be missed.

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Accession: 003199146



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