Nocardiosis
Conditions
Keywords
Nocardiosis, Nocardia spp., Radiological monitoring, Cerebral involvement
Brief summary
Nocardiosis is a rare infection caused by bacteria of the genus Nocardia spp. It primarily affects immunocompromised individuals, such as solid organ or hematopoietic stem cell transplant recipients, as well as individuals with anti-GM-CSF antibodies. The infection typically begins by inhalation, affecting the lungs, with frequent hematogenous spread to the brain and soft tissues. Cerebral involvement is present in 20 to 40% of cases, although 40% of patients remain neurologically asymptomatic. Treatment consists of prolonged antibiotic therapy and, sometimes, surgical drainage for large or refractory abscesses. Mortality associated with cerebral involvement varies between 20 and 40%. Although radiological improvements are observed under treatment, the link between image changes and clinical prognosis remains uncertain. Regular radiological monitoring is recommended during and after treatment, although the expected evolution has not been described in the literature.
Detailed description
Nocardiosis is a rare infection caused by bacteria of the genus Nocardia spp. It primarily affects immunocompromised individuals, such as solid organ or hematopoietic stem cell transplant recipients, as well as individuals with anti-GM-CSF antibodies. The infection typically begins by inhalation, affecting the lungs, with frequent hematogenous spread to the brain and soft tissues. Cerebral involvement is present in 20 to 40% of cases, although 40% of patients remain neurologically asymptomatic. Brain imaging is essential for diagnosis, with MRI often being preferred due to its sensitivity. Images often show multiple abscesses, but without sufficient specificity to differentiate nocardiosis from other pathogens. New MRI techniques could improve lesion characterization. Treatment consists of prolonged antibiotic therapy and, sometimes, surgical drainage for large or refractory abscesses. Mortality associated with cerebral involvement varies between 20 and 40%. Although radiological improvements are observed under treatment, the link between image changes and clinical prognosis remains uncertain. Regular radiological monitoring is recommended during and after treatment, although the expected evolution has not been described in the literature.
Interventions
Collection of data from the patient's medical file.
Sponsors
URC-CIC Paris Descartes Necker Cochin
Assistance Publique - Hôpitaux de Paris
Study design
Observational model
CASE_ONLY
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Minor or adult patient with cerebral nocardiosis, defined by the presence of compatible clinical and radiological signs associated with the detection of Nocardia spp. in a biological sample (cerebral or extracerebral). * With available imaging tests: * All patients with 3 brain imaging tests at the 3 stages of treatment: within 2 weeks of diagnosis, upon transition to maintenance treatment (3-6 weeks after the start of treatment), and at the end of treatment (between 1 month before and 1 month after the end of antibiotic treatment). MRI scans are preferred; in the absence of MRI images, contrast-enhanced CT scans will be included. * OR: any patient who has undergone an MRI and a contrast-enhanced CT scan within two weeks of diagnosis, with the two tests performed within 72 hours of each other. * OR: any patient with a multimodal brain MRI at any time during infection, preferably within one month of diagnosis.
Exclusion criteria
* Refusal or impossibility of information.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage reduction in cerebral nocardiosis lesions | 12 months | Percentage reduction in cerebral nocardiosis lesions in patients with a favorable evolution and those with an unfavorable evolution at 12 months from diagnosis. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of CT brain scans suggestive of cerebral nocardiosis | 12 months | Percentage of CT brain scans finding abnormalities suggestive of cerebral nocardiosis, considering MRI as the gold standard for diagnosing cerebral nocardiosis. |
| Description of the variation in radiological presentation of cerebral nocardiosis lesions | 12 months | Description of the variation in radiological presentation (number of abscesses, abscesses size, contrast uptake, vasculitic lesions, associated ventriculitis) according to the patient's background (transplantation, anti-GM-CSF antibodies, allogeneic CSH graft, others). |
| Percentage of cerebral vasculitis lesions | 12 months | Percentage of cerebral vasculitis lesions on brain MRI. |
Countries
France
Contacts
Primary ContactMargaux MD Garzaro
Backup ContactHélène Morel
Outcome results
None listed