Nocardia ventriculitis [Neurosurgery Wiki]

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====== Nocardia ventriculitis ======

A 47-year-old woman underwent an [[endoscopic third ventriculostomy]] and a left [[retrosigmoid craniotomy]] for a [[schwannoma]] removal. [[Meninge]]al symptoms began a week later, in association with [[C reactive protein]] rise and [[leukocytosis]]. The [[cerebrospinal fluid analysis]] [[examination]] was clear with [[hypoglycorrhachia]], hyperprotidorrachia, and [[polymorphonuclear]] cells. The [[bacteria culture test]] was negative. At the brain magnetic resonance imaging (MRI) [[purulent]] material was described in the [[occipital horn]]s. Empirical [[broad-spectrum antibiotics]] was given for 31 days until the brain MRI showed a resolution of the infection. Ten days later, the patient was admitted to the hospital because of new [[meningitis]] symptoms. Cerebrospinal fluid culture and Polymerase-chain reaction (PCR) Multiplex for the most important meningitis viruses and bacteria tested negative. A broad-spectrum antibiotic therapy was started with no benefit; thus, a broad-spectrum antifungal therapy was added with little success on clinical status.
Meanwhile, a 16s and 18s rRNA PCR was executed on a previous Cerebrospinal fluid with negative results, excluding bacterial and fungal infections. For this reason, all the therapies were stopped. After a few days, high fever and meningeal signs reappeared. The brain MRI showed a meningoventriculitis. An [[Ommaya]] catheter with a reservoir was inserted and the drawn CSF resulted in the growth of [[Nocardia farcinica]]. Antibiogram-based antibiotic therapy was started with intravenous [[imipenem]] and [[trimethoprim]]-[[sulfamethoxazole]], showing clinical benefit. The patient was sent home with oral [[linezolid]] and [[amoxicillin]]/[[clavulanate]] for a total of 12 months of therapy. Nocardia rarely causes post-neurosurgical complications in a [[nosocomial]] setting. This case shows the difficulty in detecting [[Nocardia]] and the importance of the correct microbiological sample and [[antibiogram]]-based antibiotic therapy to achieve successful treatment
((Ponta G, Bradanini L, Morena V, Mauri C, Ripa M, Uberti Foppa C, Castagna A, Luzzaro F, Piconi S. Post-neurosurgical Nocardia meningoventriculitis: a case report and review of the literature. New Microbiol. 2023 Feb;46(1):75-80. PMID: 36853823.)).