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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty culture-documented cases of infection caused by Xylohypha bantiana (synonyms, Cladosporium bantianum, Cladosporium trichoides) were identified in the world literature; 26 cases involved the central nervous system (CNS) and most frequently presented as chronic headache followed by fever and hemiparesis. Phaeohyphomycosis due to X. bantiana occurs worldwide, predominantly in young males. Pharmacologic immunosuppression was not an important predisposing factor. However, four patients had a history of systemic nocardiosis or facial phaeohyphomycosis caused by Alternaria species. Chest radiography revealed no pulmonary infiltrates. Computed tomography of the brain demonstrated a mass defect, the frontal lobes being the most common sites of infection. Lumbar puncture usually demonstrated an elevated opening pressure, elevated cerebrospinal fluid protein level, hypoglycorrhachia, and cultures were negative. No preoperative clinical or laboratory features indicated CNS fungal infection. Complete neurosurgical resection of the lesion was the most important therapeutic intervention determining survival; systemic antifungal chemotherapy apparently did not influence outcome. The survival rate of 35% for all patients and of 45% for all neurosurgically treated patients was higher than had previously been reported, probably because patients dying from infections confirmed only histopathologically were excluded.
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PMID:Infections due to Xylohypha bantiana (Cladosporium trichoides). 267 37

Cerebral nocardiosis is an uncommon disease which has not been previously reported in Taiwan. We describe a 70-years-old man who, known to have a history of rectal cancer, developed a cerebral nocardial abscess. The patient was admitted with a week history of gradual weakness of the left limbs. There was neither fever nor headache. Neurological examination disclosed left hemiparesis. Computed tomography of the brain revealed a decreased density in the right parietal region with a ring enhancement. Biopsy of the cerebral lesion showed Nocardia asteroides.
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PMID:Nocardial cerebral abscess: report of a case. 276 20

We report a case of a 35-year-old man with nocardiosis infection involving soft tissue and the central nervous system who had received a cadaveric donor kidney. The patient was admitted with fever, malaise and right shoulder pain. Soft tissue abscess was seen on ultrasound examination. It was presumed due to gram (+) microorganisms, so 4 g day (IV) ampicillin/sulbactam was started empirically once the abscess was drained. Nocardia asteroides was found in the pus specimen. On the second day in hospital, severe headache, ataxia and signs of meningeal irritation appeared. The cranial CT showed two intracranial abscesses in the frontal lobe and cerebellum. We assumed Nocardia asteroides was the infective agent for the cerebral abscesses, so antibiotic therapy was switched to trimethoprim-sulphamethox-asole (3x160/800 mg/d). Nausea and vomiting occurred on the fifth day of therapy, improving after drainage from the frontal abscess. However, these complaints recurred five days later. CT showed cerebellar abscess had become bigger. The patient's complaints improved after the second surgical drainage. N. asteroides was again grown in the aspiration fluids of both cerebral abscesses. Complete regression of the abscesses was seen in the CT after two months. Co-trimoxazole was continued for six months then withdrawn. Graft dysfunction was not observed. Early medical and surgical interventions may be life-saving in this potentially lethal disease.
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PMID:Successful therapy combined with surgery for severe post-transplant nocardiosis. 1150 55

A 52-year-old woman was taking 10 mg of prednisolone on alternate days for the treatment of autoimmune hemolytic anemia. She was informed of an abnormality on a chest X-ray film about 3 months previously and was admitted to our hospital with sudden onset of chest pain and fever. On the following day, she underwent transthoracic needle biopsy and the lung lesion was diagnosed as pulmonary nocardiosis. She showed improvement of fever and the lung lesion with administration of an antibacterial agent, but suddenly developed vomiting and headache. Brain MRI revealed multiple brain abscesses at more than 20 sites. A subsequent change of the antibacterial agent achieved control of the lung lesion and brain lesions. This case shows that prednisolone can cause nocardiosis as an opportunistic infection even at a low dose and that antibacterial agents act differently on the lung and brain lesions caused by this organism.
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PMID:[Pulmonary nocardiosis complicated with multiple brain abscess]. 1599 89

A splenectomized patient with systemic lupus erythematosus, who had previously been treated with high doses of corticosteroids, presented with headaches and symptoms of a respiratory tract infection. A magnetic resonance imaging scan of the brain revealed a ring-enhancing lesion, and Nocardia asteroides was isolated from a stereotactic biopsy specimen. After adverse reactions to a number of antibiotics, infection control was finally achieved by the new oxazolidinone drug, linezolid. Nocardiosis should be considered as a differential diagnosis in all immunocompromised patients who develop an obscure infection; delay in diagnosis and subsequent initiation of appropriate treatment often results in a fatal outcome. Linezolid is a new option for the treatment of nocardiosis and is effective when given orally.
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PMID:Systemic nocardiosis in a splenectomized patient with systemic lupus erythematosus: successful treatment using linezolid. 1704 23

Nocardia is typically regarded as an opportunistic infection, with pulmonary nocardiosis frequently disseminated to organs hematogenous by, and nearly half of these cases resulting in complicated nocardia brain abscess. Disseminated nocardia has a dismal prognosis with high mortality, and should be checked for multiple organs including the brain when nocardiosis is diagnosed. We describe the successful treatment of nocardia brain abscesses in an immunocompetent older people with pneumoconiosis by combining trimethoprim-sulfamethoxazole and ciprofloxacin. Patients had no history of fever, headache, or respiratory symptoms such as cough, or sputum until the acute hemiplegia episode. Nocardia infection is not as rare as generally assumed and should be considered as a possibility in the elderly due to its high mortality.
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PMID:[Case report of disseminated nocardiosis complicated in an elderly person with pneumoconiosis]. 1717 62

A 56-year-old man with diabetes mellitus and alcoholic liver cirrhosis was admitted on an emergency basis to our hospital for further examination of headache, general fatigue and dysarthria. He had been treated with antifungal drugs on the suspicion of pulmonary mycosis. Brain MRI revealed multiple cerebellar abscesses with ring enhancement. Due to depression of mental status despite medical treatment, he underwent suboccipital craniotomy and enucleation of the cerebellar abscess, resulting in marked improvement of consciousness level. As the culture of his abscess content yielded Nocardia farcinica, the definite diagnosis of Nocardial cerebellar abscesses and pulmonary Nocardiosis were made. Pulmonary Nocardiosis improved by oral co-trimoxazole treatment. Moreover, no recurrence of cerebellar abscesses was evident. This case indicates that the possibility of Nocardial infection should be considered in the immuno-compromised hosts.
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PMID:[Pulmonary nocardiosis complicated with multiple cerebellar abscess]. 1919 10

Nocardia species are aerobic, gram positive filamentous branching bacteria that have the potential to cause localized or disseminated infection. Nocardiosis is a rare disease that usually affects immunocompromised patients and presents as either pulmonary, cutaneous or disseminated nocardiosis. Forty-two year-old hispanic male presented to our care with bilateral lower extremity weakness, frontal headache, subjective fever, nausea, and vomiting. Brain computed tomography (CT) revealed multiple hyperdense lesions with vasogenic edema in the frontal, parietal and left temporal lobes. Chest CT demonstrated bilateral cavitary nodules in the lung and right hilar lymphadenopathy. Brain magnetic resonance imaging revealed multiple bilateral supratentorial and infratentorial rim enhancing lesions involving the subcortical gray-white matter interface with vasogenic edema. Patient was started on empiric therapy for unknown infectious etiology with no response. He eventually expired and autopsy findings revealed a right hilar lung abscess and multiple brain abscesses. Microscopic and culture findings from tissue sample during autopsy revealed nocardia wallacei species with multidrug resistance. The cause of death was stated as systemic nocadiosis (nocardia pneumonitis and encephalitis). The presence of simultaneous lung and brain abscesses is a reliable indication of an underlying Nocardia infection. An increased awareness of the various presentations of nocardiosis and a high index of clinical suspicion can help in a rapid diagnosis and improve survival in an otherwise fatal disease. This case highlights the importance of obtaining a tissue biopsy for definitive diagnosis on the initial presentation when an infectious process is considered in the differential diagnosis and early treatment can be initiated.
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PMID:A complicated case of an immunocompetent patient with disseminated nocardiosis. 2475 10

A 34-year-old immunocompetent man weighing 95 kg was operated for a small left parietal scalp swelling in the year 2002. He was well until 2008, when he developed chronic diffuse headache, vomiting and drowsiness. The left parietal dura and overlying vault biopsy showed evidence of granulomatous pachymeningitis with osteomyelitis secondary to nocardiosis. He had responded well to inadequate antibiotic therapy. After a dormant period of 3 years, there was recrudescence of severe raised intracranial tension symptoms in 2011. Magnetic resonance imaging showed diffuse pachymeningeal thickening mainly involving the occipital dura, posterior falx, and tentorium cerebelli. In addition, well-defined small nodules with hypointense signals on both T1- and T2-weighted images were seen in occipital lobes. Patient was treated with three drug regime with good recovery at 3 months follow-up. This is a rare case of central nervous system nocardiosis with skull vault osteomyelitis and a protracted clinical course.
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PMID:Central nervous system nocardiosis with granulomatous pachymeningitis and osteomyelitis of skull vault. 2494 82

Nocardia infections primarily begin in the lungs and spread hematogenously to other sites in the body. Thus, a Nocardia brain abscess is not a completely uncommon occurrence. However, a Nocardia brain abscess complicated by a middle cerebral artery and infectious intracranial aneurysm is a very rare clinical entity. We present a case of an infectious intracranial aneurysm with an associated Nocardia brain abscess that required surgical intervention and resection. The patient was an immunocompetent 60-year-old male who presented with a chief complaint of headache and was found to have an infected intracranial aneurysm and cerebral abscess. He underwent drainage of the abscess with subsequent resection of the infected aneurysm. Cultures from both the blood vessel and brain tissue grew Nocardia abscessus. He was successfully treated with 6 weeks of ceftriaxone and high-dose trimethoprim-sulfamethoxazole. Infectious intracranial aneurysms of the brain caused by Nocardia are rare occurrences, and only a single previous case has been described in the literature. The outcomes of this condition can be catastrophic if it is not treated with a combination of surgery and intravenous antibiotics. The guidelines for the management of this infection are not well defined at this time.
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PMID:Nocardia abscessus-related intracranial aneurysm of the internal carotid artery with associated brain abscess: A case report and review of the literature. 2672 61


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