Abstract：
BACKGROUND: Nocardia infection is commonly regarded as an opportunistic pulmonary pathogen affecting debilitated or immunocompromised individuals. Brain abscesses caused by Nocardia farcinica are rare and pose a diagnostic challenge. Traditional diagnostic techniques for identifying Nocardia species, such as blood culture, microscopy, and pathology, have shown inadequate performance. In the reported case, we applied metagenomic next-generation sequencing (mNGS) to diagnose a case of brain abscess due to N. farcinica.
METHODS: A 66-year-old female developed a brain abscess after sustaining a hand injury. The patient exhibited a gradual change in personality and experienced tremors in her right upper limb for a duration of 1 month.
METHODS: The pathogen responsible for the multiple brain abscesses was identified in the cerebrospinal fluid as N. farcinica through mNGS.
METHODS: Antibiotic treatment included trimethoprim-sulfamethoxazole, linezolid, amikacin, meropenem, and moxifloxacin.
RESULTS: The patient\'s symptoms and signs improved significantly after administration of antibiotics to which the pathogen is known to be sensitive. After 5 months of follow-up, magnetic resonance imaging of the head showed that the abscess was basically cured. The patient lived a normal life with no adverse drug reactions.
CONCLUSIONS: Nocardia brain infection is characterized by an insidious onset and lacks distinctive clinical and imaging features. mNGS was advantageous for the timely identification and management of Nocardia-associated brain abscess in the present case and obviated the need for invasive brain surgery. Expeditious and precise diagnosis coupled with prompt antibiotic therapy can significantly reduce the mortality rate associated with this condition.
METHODS: A 66-year-old female developed a brain abscess after sustaining a hand injury. The patient exhibited a gradual change in personality and experienced tremors in her right upper limb for a duration of 1 month.
METHODS: The pathogen responsible for the multiple brain abscesses was identified in the cerebrospinal fluid as N. farcinica through mNGS.
METHODS: Antibiotic treatment included trimethoprim-sulfamethoxazole, linezolid, amikacin, meropenem, and moxifloxacin.
RESULTS: The patient\'s symptoms and signs improved significantly after administration of antibiotics to which the pathogen is known to be sensitive. After 5 months of follow-up, magnetic resonance imaging of the head showed that the abscess was basically cured. The patient lived a normal life with no adverse drug reactions.
CONCLUSIONS: Nocardia brain infection is characterized by an insidious onset and lacks distinctive clinical and imaging features. mNGS was advantageous for the timely identification and management of Nocardia-associated brain abscess in the present case and obviated the need for invasive brain surgery. Expeditious and precise diagnosis coupled with prompt antibiotic therapy can significantly reduce the mortality rate associated with this condition.
摘要：
背景：诺卡氏菌感染通常被认为是影响衰弱或免疫受损个体的机会性肺部病原体。由诺卡氏菌引起的脑脓肿很少见，并提出了诊断挑战。用于识别诺卡氏菌物种的传统诊断技术，比如血培养,显微镜,和病理学，表现不足。在报告的案例中，我们应用宏基因组下一代测序（mNGS）来诊断一例由N.farcinica引起的脑脓肿。
方法：一名66岁女性在手受伤后出现脑脓肿。患者表现出人格的逐渐变化，并在右上肢经历了持续1个月的震颤。
方法：通过mNGS在脑脊液中鉴定出导致多发性脑脓肿的病原体为N.farcinica。
方法：抗生素治疗包括甲氧苄啶-磺胺甲恶唑，利奈唑胺,阿米卡星，美罗培南,和莫西沙星.
结果：使用已知对病原体敏感的抗生素后，患者的症状和体征明显改善。经过5个月的随访，头部磁共振成像显示脓肿基本治愈。患者生活正常，无药物不良反应。
结论：诺卡氏菌脑感染的特点是发病隐匿，缺乏独特的临床和影像学特征。在这种情况下，mNGS有利于及时识别和管理诺卡氏菌相关的脑脓肿，并且无需进行侵入性脑部手术。快速和精确的诊断加上及时的抗生素治疗可以显着降低与这种情况相关的死亡率。
方法：一名66岁女性在手受伤后出现脑脓肿。患者表现出人格的逐渐变化，并在右上肢经历了持续1个月的震颤。
方法：通过mNGS在脑脊液中鉴定出导致多发性脑脓肿的病原体为N.farcinica。
方法：抗生素治疗包括甲氧苄啶-磺胺甲恶唑，利奈唑胺,阿米卡星，美罗培南,和莫西沙星.
结果：使用已知对病原体敏感的抗生素后，患者的症状和体征明显改善。经过5个月的随访，头部磁共振成像显示脓肿基本治愈。患者生活正常，无药物不良反应。
结论：诺卡氏菌脑感染的特点是发病隐匿，缺乏独特的临床和影像学特征。在这种情况下，mNGS有利于及时识别和管理诺卡氏菌相关的脑脓肿，并且无需进行侵入性脑部手术。快速和精确的诊断加上及时的抗生素治疗可以显着降低与这种情况相关的死亡率。
