Abstract：
BACKGROUND: Central nervous system (CNS) nocardiosis is a rare suppurative disease caused by the genus Nocardia. It is found most frequently in immunocompromised individuals.
OBJECTIVE: In this study, we retrospectively reviewed the clinical presentations, laboratory examination, therapy and outcomes of 9 patients with CNS nocardiosis diagnosed using metagenomic next-generation sequencing (mNGS) in our hospital.
METHODS: We reviewed 9 patients with confirmed diagnosis of CNS Nocardia infection from January 2017 to December 2021 in the Department of Neurology at The Third Affiliated Hospital, Sun Yat-sen University (Guangzhou, China). In addition, we searched literature related to CNS Nocardia infection on PubMed and included all case reports with proven CNS nocardiosis since 2016.
RESULTS: The metagenomic next-generation sequencing (mNGS) of CSF can be used for the rapid diagnosis of nocardiosis in CNS and N. farcinica are the most commonly isolated species. Underlying autoimmune diseases, immunosuppressive agents including corticosteroids and organ transplantation are predisposing factors of developing CNS nocardiosis. Single or multiple hyper-enhanced ring lesions indicative of cerebral abscesses are commonly presented in brain imaging. Trimethoprim-sulfamethoxazole (TMP-SMX) is used as the primary agent for the antibacterial therapy and in combination with other antibacterial agents.
CONCLUSIONS: Our study demonstrated that mNGS of CSF can be conducted for definitive and rapid diagnosis for CNS nocardiosis.
OBJECTIVE: In this study, we retrospectively reviewed the clinical presentations, laboratory examination, therapy and outcomes of 9 patients with CNS nocardiosis diagnosed using metagenomic next-generation sequencing (mNGS) in our hospital.
METHODS: We reviewed 9 patients with confirmed diagnosis of CNS Nocardia infection from January 2017 to December 2021 in the Department of Neurology at The Third Affiliated Hospital, Sun Yat-sen University (Guangzhou, China). In addition, we searched literature related to CNS Nocardia infection on PubMed and included all case reports with proven CNS nocardiosis since 2016.
RESULTS: The metagenomic next-generation sequencing (mNGS) of CSF can be used for the rapid diagnosis of nocardiosis in CNS and N. farcinica are the most commonly isolated species. Underlying autoimmune diseases, immunosuppressive agents including corticosteroids and organ transplantation are predisposing factors of developing CNS nocardiosis. Single or multiple hyper-enhanced ring lesions indicative of cerebral abscesses are commonly presented in brain imaging. Trimethoprim-sulfamethoxazole (TMP-SMX) is used as the primary agent for the antibacterial therapy and in combination with other antibacterial agents.
CONCLUSIONS: Our study demonstrated that mNGS of CSF can be conducted for definitive and rapid diagnosis for CNS nocardiosis.
摘要：
背景：中枢神经系统（CNS）诺卡氏菌属引起的罕见化脓性疾病。在免疫受损的个体中最常见。
目的：在本研究中，我们回顾性回顾了临床表现，实验室检查,在我院使用宏基因组下一代测序（mNGS）诊断的9例中枢神经系统诺卡心症患者的治疗和结局。
方法：我们回顾了2017年1月至2021年12月在第三附属医院神经内科确诊的9例中枢神经系统诺卡氏菌感染患者，中山大学(广州,中国）。此外,我们在PubMed上检索了与中枢神经系统诺卡氏菌感染相关的文献,纳入了2016年以来已证实的中枢神经系统诺卡氏菌病的所有病例报告.
结果：CSF的宏基因组下一代测序（mNGS）可用于快速诊断CNS中的诺卡病，而N.farcinica是最常见的分离物种。潜在的自身免疫性疾病，包括皮质类固醇和器官移植在内的免疫抑制剂是发生CNS诺卡心症的诱发因素。脑成像中通常会出现指示脑脓肿的单个或多个过度增强环病变。甲氧苄啶-磺胺甲恶唑（TMP-SMX）用作抗菌治疗的主要药物，并与其他抗菌剂联合使用。
结论：我们的研究表明，CSF的mNGS可用于确定和快速诊断中枢神经系统诺卡心症。
目的：在本研究中，我们回顾性回顾了临床表现，实验室检查,在我院使用宏基因组下一代测序（mNGS）诊断的9例中枢神经系统诺卡心症患者的治疗和结局。
方法：我们回顾了2017年1月至2021年12月在第三附属医院神经内科确诊的9例中枢神经系统诺卡氏菌感染患者，中山大学(广州,中国）。此外,我们在PubMed上检索了与中枢神经系统诺卡氏菌感染相关的文献,纳入了2016年以来已证实的中枢神经系统诺卡氏菌病的所有病例报告.
结果：CSF的宏基因组下一代测序（mNGS）可用于快速诊断CNS中的诺卡病，而N.farcinica是最常见的分离物种。潜在的自身免疫性疾病，包括皮质类固醇和器官移植在内的免疫抑制剂是发生CNS诺卡心症的诱发因素。脑成像中通常会出现指示脑脓肿的单个或多个过度增强环病变。甲氧苄啶-磺胺甲恶唑（TMP-SMX）用作抗菌治疗的主要药物，并与其他抗菌剂联合使用。
结论：我们的研究表明，CSF的mNGS可用于确定和快速诊断中枢神经系统诺卡心症。
