{"id":2291,"date":"2021-09-20T11:05:31","date_gmt":"2021-09-20T09:05:31","guid":{"rendered":"https:\/\/www.newslab.sk\/nocardia-transvalensis-ako-povodca-multilokularneho-abscesu-mozgu-u-imunokompetentneho-pacienta\/"},"modified":"2021-09-20T11:11:35","modified_gmt":"2021-09-20T09:11:35","slug":"nocardia-transvalensis-as-an-agent-causing-multifocal-cerebral-abscess-in-an-immunocompromised-patient","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/nocardia-transvalensis-as-an-agent-causing-multifocal-cerebral-abscess-in-an-immunocompromised-patient\/","title":{"rendered":"Nocardia transvalensis as an agent causing multifocal cerebral abscess in an immunocompromised patient"},"content":{"rendered":"

*A rare case of autochthonous human dirofilariasis with the manifestation of pseudotumor of the epididymis caused by helminth Dirofilaria repens<\/strong><\/span><\/p>\n

 <\/p>\n

\u00davod<\/strong><\/h3>\n

Absces mozgu sp\u00f4soben\u00fd Nocardia spp. <\/em>je p\u00f4vodcom pribli\u017ene 1-2 % zo v\u0161etk\u00fdch abscesov mozgu(1). \u010castej\u0161ie sa vyskytuje u imunosuprimovan\u00fdch pacientov ako oport\u00fanna infekcia. Jeho v\u00fdskyt v\u0161ak nie je vyl\u00fa\u010den\u00fd ani u imunokompetentn\u00fdch os\u00f4b. U imonosuprimovan\u00fdch pacientov \u00famrtnos\u0165 dosahuje 55 % a u imunokompetentn\u00fdch pacientov 20 %, z tohto d\u00f4vodu je nevyhnutn\u00e1 r\u00fdchla a presn\u00e1 diagnostika a cielen\u00e1 terapia(2).<\/p>\n

 <\/p>\n

Kazuistika<\/h3>\n

73-ro\u010dn\u00fd pacient s anamn\u00e9zou arteri\u00e1lnej hypertenzie, diabetu mellitu 2. typu lie\u010den\u00fd peror\u00e1lnymi antidiabetikami, bol prijat\u00fd na Neurochirurgick\u00fa kliniku LFUK a UNB s diagn\u00f3zou multilokul\u00e1rneho abscesu mozgu parieto-temporo-okcipit\u00e1lne v\u013eavo. V predchorob\u00ed v j\u00fani 2019 absolvoval neurochirurgick\u00fd v\u00fdkon, ktor\u00fd bol indikovan\u00fd pre impres\u00edvnu frakt\u00faru kalvy v\u013eavo po p\u00e1de z bicykla. V\u00fdkon prebehol bez komplik\u00e1ci\u00ed, frakt\u00fara bola reponovan\u00e1 a fixovan\u00e1 mikrodlahami (obr\u00e1zok 1)<\/strong>.<\/p>\n

Poopera\u010dn\u00fd priebeh a opakovan\u00e9 kontroly neurol\u00f3gom boli vyhovuj\u00face. Pacient bol orientovan\u00fd, re\u010d bola zrete\u013ene artikulovan\u00e1, bola zisten\u00e1 len l\u00e9zia nervus abducens a porucha konjugovan\u00e9ho poh\u013eadu. V okt\u00f3bri 2019 bol pacient hospitalizovan\u00fd na gerontopsychiatrickom oddelen\u00ed pre pokus o suic\u00eddium. Pod\u013ea \u00fadajov bol pacient posledn\u00fd mesiac dezorientovan\u00fd, depres\u00edvne laden\u00fd s poruchou pam\u00e4ti. Po\u010das hospitaliz\u00e1cie boli u pacienta zaznamenan\u00e9 febrility, zv\u00fd\u0161en\u00e9 z\u00e1palov\u00e9 parametre (leukocyt\u00f3za, Ceakt\u00edvny prote\u00edn). Pre zmenen\u00fd neurologick\u00fd status prebehla konzult\u00e1cia s neurol\u00f3gom, ktor\u00fd indikoval CT mozgu, na ktorom sa zobrazilo lo\u017eisko parieto-okcipit\u00e1lne v\u013eavo s perifok\u00e1lnym ed\u00e9mom, mo\u017en\u00fd glioblast\u00f3m. V r\u00e1mci diferenci\u00e1lnej diagnostiky bola doplnen\u00e1 MR mozgu, na ktorej sa zobrazila lalo\u010dnat\u00e1 multicystoidn\u00e1 form\u00e1cia parieto-temporo-okcipit\u00e1lne v\u013eavo ve\u013ekosti 57 x 46 x 51 milimetrov s diskr\u00e9tnymi hemor\u00e1giami na perif\u00e9rii, okolitou meningit\u00eddou, ventrikulit\u00eddou a s purulentn\u00fdm obsahom v oboch bo\u010dn\u00fdch komor\u00e1ch. Z\u00e1rove\u0148 bol pr\u00edtomn\u00fd \u00fatlak komorov\u00e9ho syst\u00e9mu s presunom stredo\u010diarov\u00fdch \u0161trukt\u00far doprava o 6 milimetrov (obr\u00e1zok 2)<\/strong>.<\/p>\n

S t\u00fdmto n\u00e1lezom bol pacient v novembri 2019 prelo\u017een\u00fd na Neurochirurgick\u00fa kliniku LFUK a UNB. Pri prijat\u00ed bol pacient pri vedom\u00ed, ale imobiln\u00fd, nekomunikuj\u00faci, plne odk\u00e1zan\u00fd na pomoc druhej osoby, objekt\u00edvne boli pr\u00edtomn\u00e9 meninge\u00e1lne pr\u00edznaky. Zo vstupn\u00fdch laborat\u00f3rnych parametrov bola zaznamenan\u00e1 iba leukocyt\u00f3za (19,41 x 109), ostatn\u00e9 parametre aj CRP boli v norme. Sn\u00edmka p\u013e\u00fac bola bez patologick\u00e9ho n\u00e1lezu. Pacient absolvoval opakovan\u00fa trepan\u00e1ciu a evaku\u00e1ciu abscesov\u00fdch dut\u00edn, z ktor\u00fdch sa aspir\u00e1ciou podarilo evakuova\u0165 pribli\u017ene 37,5 mililitra \u017eltozelen\u00e9ho hnisav\u00e9ho obsahu. Bola za\u010dat\u00e1 empirick\u00e1 kombinovan\u00e1 antibiotick\u00e1 terapia (vankomyc\u00edn + ceftriaxon) a symptomatick\u00e1 lie\u010dba. Zo vzoriek hnisu, ktor\u00e9 boli zaslan\u00e9 na kultiva\u010dn\u00e9 vy\u0161etrenie do n\u00e1\u0161ho mikrobiologick\u00e9ho laborat\u00f3ria, sme na 3. de\u0148 izolovali drobn\u00e9 biele kol\u00f3nie, rast\u00face ako popra\u0161ok na krvnom agare (obr\u00e1zok 3)<\/strong>.<\/p>\n

Kme\u0148 bol identifikovan\u00fd met\u00f3dou hmotnostnej spektrometrie ako Nocardia spp. <\/em>(MALDI \u2013 TOF, Brucker, Nemecko) a n\u00e1sledne bli\u017e\u0161ie identifikovan\u00fd molekul\u00e1rnogenetick\u00fdmi met\u00f3dami, a to sekven\u00e1ciou g\u00e9nu k\u00f3duj\u00faceho 16S sRNA pou\u017eit\u00edm primerov 27F a 1492R ako Nocardia transvalensis. <\/em>Citlivos\u0165 na vybran\u00e9 antibiotik\u00e1 pod\u013ea literat\u00fary bola stanoven\u00e1 diskovou dif\u00faznou met\u00f3dou. Ke\u010f\u017ee neexistuj\u00fa interpreta\u010dn\u00e9 krit\u00e9ri\u00e1 na hodnotenie citlivosti na antibiotik\u00e1 pod\u013ea normy EUCAST (European committee on antimicrobial susceptibility testing), citlivos\u0165 bola stanoven\u00e1 orienta\u010dne na z\u00e1klade ve\u013ekosti inhibi\u010dn\u00fdch z\u00f3n. Testovan\u00fd kme\u0148 bol orienta\u010dne citliv\u00fd na cefotax\u00edm, ceftriaxon, meropen\u00e9m, ciprofloxac\u00edn a linezolid. Ale proti trimetoprim-sulfametoxazolu, ktor\u00fd je v literat\u00fare uv\u00e1dzan\u00fd ako liek vo\u013eby abscesov mozgu sp\u00f4soben\u00fd Nocardia spp.<\/em>(7), bol vykultivovan\u00fd kme\u0148 rezistentn\u00fd. Antibiotick\u00e1 lie\u010dba bola upraven\u00e1 pod\u013ea orienta\u010dnej citlivosti na meropen\u00e9m a linezolid. Na kontrolnej MR mozgu bol n\u00e1lez len miernej regresie abscesov\u00fdch lo\u017e\u00edsk so zakrv\u00e1can\u00edm suba- k\u00fatneho charakteru, pretrv\u00e1valo rez\u00edduum cystoidnej lalo\u010dnatej form\u00e1cie s perifok\u00e1lnym ed\u00e9mom a miernou regresiou expanz\u00edvnych prejavov (obr\u00e1zok 4)<\/strong>.<\/p>\n

U pacienta nastalo prechodn\u00e9 celkov\u00e9 zlep\u0161enie stavu vedomia, sna\u017eil sa komunikova\u0165, vyhovel po\u017eiadavk\u00e1m, bol orientovan\u00fd osobou. \u010eal\u0161ia neurochirurgick\u00e1 intervencia nebola indikovan\u00e1. Pacient bol prelo\u017een\u00fd na intern\u00e9 oddelenie, na ktorom sa pokra\u010dovalo v pod\u00e1van\u00ed intraven\u00f3znej antibiotickej lie\u010dby. Napriek komplexnej lie\u010dbe stav pacienta postupne progredoval a pribli\u017ene mesiac od izol\u00e1cie Nocardia transvalensis <\/em>z abscesu mozgu pacient zomrel. Ako pr\u00ed\u010dina smrti bolo uveden\u00e9 kardiorespira\u010dn\u00e9 zlyhanie.<\/p>\n

<\/h3>\n

Diskusia<\/h3>\n

Nocardia spp. <\/em>s\u00fa striktne aer\u00f3bne, grampozit\u00edvne a\u017e gramlabiln\u00e9 vetviace sa pali\u010dky. <\/em>V minulosti boli nokardie pre tvorbu h\u00fdf pova\u017eovan\u00e9 za huby(3). Morfologicky sa podobaj\u00fa anaer\u00f3bnemu rodu Actinomyces<\/em>, a preto s\u00fa ozna\u010dovan\u00e9 ako aer\u00f3bne aktinomyc\u00e9ty(4). Na rozdiel od aktinomyc\u00e9t s\u00fa \u010diasto\u010dne acidorezistentn\u00e9. Pri farben\u00ed met\u00f3dou pod\u013ea Grama sa nokardie javia ako gramnegat\u00edvne s grampozit\u00edvnymi granu- lami (obr\u00e1zok 5)<\/strong>(5).<\/p>\n

Nocardia spp. <\/em>rast\u00fa na be\u017en\u00fdch kultiva\u010dn\u00fdch p\u00f4dach po troch a\u017e piatich d\u0148och. Na krvnom agare tvoria kol\u00f3nie v po dobe bieleho alebo zamatov\u00e9ho popra\u0161ku, pevne lipn\u00faceho na agar. Pre tento rod je jedine\u010dn\u00e1 pr\u00edtomnos\u0165 aeri\u00e1lnych h\u00fdf a u\u017e spom\u00ednan\u00e1 acidorezistencia(3). Nokardie patria medzi oport\u00fanne patog\u00e9nne bakt\u00e9rie. Zdrojom infekcie je p\u00f4da alebo voda(5). Ochorenie sa \u0161\u00edri respira\u010dnou cestou, cez poranenia alebo sekund\u00e1rne hematog\u00e9nnym rozsevom. Nebol dok\u00e1zan\u00fd medzi\u013eudsk\u00fd prenos ani prenos zo zviera\u0165a na \u010dloveka. Pravdepodobn\u00fd zdroj infekcie u prezentovan\u00e9ho pacienta bol predch\u00e1dzaj\u00faci \u00faraz hlavy a kontamin\u00e1cia rany p\u00f4dou. Infekcie sp\u00f4sobuj\u00fa naj\u010dastej\u0161ie tri druhy nokardi\u00ed: Nocardia brasiliensis, Nocardia asteroides complex <\/em>a Nocardia caviae<\/em>. Infekcie sa vo viac ako 90 % vyskytuj\u00fa u imunosuprimovan\u00fdch pacientov (onkologick\u00ed, HIV pozit\u00edvni, pacienti po tranplant\u00e1cii) alebo u pacientov lie\u010den\u00fdch imunosupres\u00edvami(6).<\/p>\n

Nokardi\u00f3za je exog\u00e9nna, ak\u00fatna, subak\u00fatna alebo chronick\u00e1 infekcia s tendenciou k remisi\u00e1m a exacerb\u00e1ci\u00e1m. Klinick\u00e9 prejavy s\u00fa ne\u0161pecifick\u00e9 a zah\u0155\u0148aj\u00fa hor\u00fa\u010dku a org\u00e1nov\u00e9 pr\u00edznaky pod\u013ea toho, kde je infekcia lokalizovan\u00e1. Naj\u010dastej\u0161ie doch\u00e1dza k p\u013e\u00facnemu po\u0161kodeniu, m\u00f4\u017ee v\u0161ak postihn\u00fa\u0165 ktor\u00fdko\u013evek org\u00e1n, v ktorom Nocardia spp. <\/em>vyvol\u00e1va tvorbu abscesov(7).<\/p>\n

Pri syst\u00e9movej infekcii sp\u00f4sobenej Nocardia spp<\/em>. doch\u00e1dza a\u017e v 45 % k tvorbe abscesov v mozgu. V 40 % je pr\u00edtomn\u00fd len absces mozgu, bez postihnutia in\u00fdch org\u00e1nov. Pri infekci\u00e1ch centr\u00e1lneho nervov\u00e9ho syst\u00e9mu bola op\u00edsan\u00e1 aj meningit\u00edda a postihnutie miechy(8). Klinick\u00fd obraz abscesu mozgu sa prejavuje lo\u017eiskov\u00fdmi neurologick\u00fdmi pr\u00edznakmi v z\u00e1vislosti od lokaliz\u00e1cie, menej \u010dasto febrilitami, boles\u0165ami hla- vy, vracan\u00edm, poruchou vedomia. Z\u00e1kladom laborat\u00f3rnej mikrobiologickej diagnostiky je mikroskopia a kultiv\u00e1cia hnisu z abscesov\u00fdch lo\u017e\u00edsk, zo vzoriek tkaniva, pr\u00edpadne histologick\u00e9 vy\u0161etrenie bioptick\u00e9ho materi\u00e1lu. Pr\u00edtomnos\u0165 nokardi\u00ed vo vy\u0161etrovan\u00fdch vzork\u00e1ch m\u00f4\u017eu potvrdi\u0165 aj genetick\u00e9 met\u00f3dy (PCR)(7). Lumb\u00e1lna punkcia je u pacientov s abscesom mozgu kontraindikovan\u00e1, preto\u017ee ako komplik\u00e1cia m\u00f4\u017ee vznikn\u00fa\u0165 herni\u00e1cia mozgu. Zobrazovac\u00edmi vy\u0161etreniami m\u00f4\u017ee absces mozgu imitova\u0165 n\u00e1dorov\u00fd proces, cievnu mozgov\u00fa pr\u00edhodu, vaskulit\u00eddu(8). V 38 % sa m\u00f4\u017ee vyskytova\u0165 aj viacpo\u010detn\u00fd absces mozgu, <\/em>pri ktorom \u00famrtnos\u0165 dosahuje a\u017e 66 %(9). Naj\u010dastej\u0161ie absces mozgu sp\u00f4sobuje N. farcinica<\/em>, ktor\u00e1 patr\u00ed medzi virulentnej\u0161ie druhy, \u010dastej\u0161ie sp\u00f4sobuje disemin\u00e1ciu a relaps ochorenia, je rezistentnej\u0161ia proti antibiotik\u00e1m v porovnan\u00ed s ostatn\u00fdmi druhmi(6,10). Vo v\u0161eobecnosti liekom vo\u013eby nokardi\u00f3zy je trimetoprim-sulfametoxazol, ku ktor\u00e9mu sa prid\u00e1vaj\u00fa cefalospor\u00edny 3. gener\u00e1cie alebo imipin\u00e9m. Pod\u013ea literat\u00fary mo\u017eno pou\u017ei\u0165 aj in\u00e9 antibiotik\u00e1, a to linezolid, tobramyc\u00edn, amikac\u00edn, tetracykl\u00edn, amoxicil\u00edn klavulan\u00e1tu(8). Pri abscesoch v\u00e4\u010d\u0161\u00edch ako 2,5 cm sa odpor\u00fa\u010da aspir\u00e1cia a dren\u00e1\u017e. Ako \u00fa\u010dinnej\u0161\u00ed postup sa uplat\u0148uje kraniot\u00f3mia a exc\u00edzia cel\u00e9ho abscesu, a to hlavne v pr\u00edpade, ak zlyh\u00e1va antibiotick\u00e1 lie\u010dba(2). Ke\u010f\u017ee ide o pomaly rast\u00face mikroorganizmy, odpor\u00fa\u010da sa dlhodob\u00e1 antibiotick\u00e1 lie\u010dba, ktor\u00e1 trv\u00e1 od 6 do 12 mesiacov(5).<\/p>\n

N. transvalensis <\/em>je raritn\u00fd p\u00f4vodca ochoren\u00ed. Podie\u013ea sa na infekci\u00e1ch p\u013e\u00fac u pacientov s cystickou fibr\u00f3zou, sp\u00f4sobuje keratit\u00eddu, absces mozgu. N. transvalensis <\/em>sa odli\u0161uje prirodzenou rezistenciou proti aminoglykozidom a varia- bilnou citlivos\u0165ou na cefalospor\u00edny 3. gener\u00e1cie, imipen\u00e9m, trimetoprim-sulfametoxazol a linezolid(11). Stanovenie citlivosti na antibiotik\u00e1 kme\u0148a vykultivovan\u00e9ho v na\u0161om laborat\u00f3riu pomocou diskovej dif\u00faznej met\u00f3dy bolo iba orienta\u010dn\u00e9. Vhodnej\u0161ie a presnej\u0161ie met\u00f3dy na stanovenie citlivosti na antibiotik\u00e1 s\u00fa pomocou E-testov alebo dilu\u010dnou met\u00f3dou. V na\u0161om laborat\u00f3riu v\u0161ak citlivos\u0165 dilu\u010dn\u00fdmi met\u00f3dami pre n\u00e1ro\u010dnos\u0165 nevykon\u00e1vame. V literat\u00fare je uveden\u00e9 hodnotenie citlivosti Nocardia spp. <\/em>na antibiotik\u00e1, ktor\u00fa vypracovala americk\u00e1 norma CLSI (Clinical & Laboratory standards institue) pomocou E-testov(12). Nie v\u0161etky E-testy m\u00e1me v na\u0161om laborat\u00f3riu dostupn\u00e9, preto sme sa rozhodli stanovi\u0165 aspo\u0148 orienta\u010dn\u00fa citlivos\u0165 na antibiotik\u00e1 pomocou dif\u00faznej disko- vej citlivosti.<\/p>\n

 <\/p>\n

Z\u00e1ver<\/h3>\n

Absces mozgu sp\u00f4soben\u00fd Nocardia spp. <\/em>je vz\u00e1cne a z\u00e1va\u017en\u00e9 ochorenie. Rozv\u00edja sa pomaly, niekedy nieko\u013eko mesiacov a\u017e rokov, \u010do s\u0165a\u017euje v\u010dasn\u00fa diagnostiku(13). Incidencia v\u00fdskytu infekci\u00ed sp\u00f4soben\u00fdch Nocardia spp. <\/em>sa pod\u013ea literat\u00fary zvy\u0161uje aj v d\u00f4sledku n\u00e1rastu pacientov po transplant\u00e1cii sol\u00eddnych org\u00e1nov a pacientov u\u017e\u00edvaj\u00facich dlhodobo imunosupres\u00edvnu lie\u010dbu(8).<\/p>\n

Cie\u013eom \u010dl\u00e1nku bolo pouk\u00e1za\u0165 na mo\u017enos\u0165 v\u00fdskytu raritn\u00e9ho patog\u00e9nu, ktor\u00e9ho diagnostika sa pomocou modern\u00fdch techn\u00edk neust\u00e1le zlep\u0161uje. Z\u00e1rove\u0148 poukazujeme na nutnos\u0165 diferenci\u00e1lnej diagnostiky. Na CT mozgu bol prvotne n\u00e1lez postkontrastne sa vysycuj\u00faceho multilokul\u00e1rneho lo\u017eiska, s\u00fdtiaceho sa na perif\u00e9ri\u00ed a centr\u00e1lne hypodenzn\u00e9ho pripom\u00ednaj\u00faceho tumor. Doplnen\u00e1 MR mozgu odhalila, \u017ee i\u0161lo o patologick\u00fa lalo\u010dnat\u00fa multicystoidn\u00fa form\u00e1ciu, v MR obraze atrib\u00fatov abscesovej kolekcie. Empirick\u00fa antibiotick\u00fa lie\u010dbu je vhodn\u00e9 upravi\u0165 pod\u013ea v\u00fdsledkov citlivosti na antibiotik\u00e1. Kme\u0148 Nocardia transvalensis <\/em>v uv\u00e1dzanej kazuistike bol rezistentn\u00fd proti lieku vo\u013eby trimetoprimu-sulfametoxazolu. Vzh\u013eadom na mo\u017enos\u0165 relapsov sa odpor\u00fa\u010da pokra\u010dova\u0165 v dlhodobom pod\u00e1van\u00ed antibiot\u00edk.<\/p>\n

 <\/p>\n

LITERAT\u00daRA<\/strong><\/p>\n

    \n
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  2. Mamelak AN, Obana WG, Flaherty JF, et Nocardial brain abscess: treatment strategies and factors influencing outcome. Neurosurgery <\/em>1994; 35:622\u2013631.<\/li>\n
  3. Murray, Rosenthal, Pfaller Medical Microbiology, Elsevier, 2016, 229- 232<\/li>\n
  4. Votava M. L\u00e9ka\u0159sk\u00e1 mikrobiologie speci\u00e1lni, Neptun, 2006, 143-144<\/li>\n
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  10. Vinciguerra et Nocardia farcinica Multiple Brain Abscesses in an Immunocompetent Patient. J Neuroinfect Dis 2014, 6;3<\/li>\n
  11. Jorge Garc\u00eda-M\u00e9ndez, Erika Carrillo-Casas, et al. Nocardia transvalensis Disseminated infekction in an immunocompromised patient with idiopathic thrombocytopenic purpura. Case Rep Infect Dis. <\/a>2016; 2016: 3818969<\/li>\n
  12. Pan Zhao, Xiujuan Zhang, Pengcheng Du, et al. Susceptibility profiles of Nocardia <\/em>to antimicrobial and antituberculotic agents detected by a microplate Alamar Blue assay. Sci Rep. <\/a>2017; 7: 43660<\/li>\n
  13. Lerner Nocardiosis. Clin Infect Dis. 1996. 22: 891-903<\/li>\n<\/ol>\n

     <\/p>\n","protected":false},"excerpt":{"rendered":"

    *A rare case of autochthonous human dirofilariasis with the manifestation of pseudotumor of the epididymis caused by helminth Dirofilaria repens   \u00davod Absces mozgu sp\u00f4soben\u00fd Nocardia spp. je p\u00f4vodcom pribli\u017ene 1-2 % zo v\u0161etk\u00fdch abscesov mozgu(1). \u010castej\u0161ie sa vyskytuje u imunosuprimovan\u00fdch pacientov ako oport\u00fanna infekcia. Jeho v\u00fdskyt v\u0161ak nie je vyl\u00fa\u010den\u00fd ani u imunokompetentn\u00fdch os\u00f4b.<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[1781],"tags":[1782,1784,1783],"class_list":["post-2291","post","type-post","status-publish","format-standard","hentry","category-bakteriologia-en","tag-absces-mozgu-en","tag-cerebral-abscess","tag-nocardia-transvalensis-en","typ_clanku-casuistry"],"acf":{"abstrakt":"

    The cerebral abscess is a purulent pocket of infection in the cerebral parenchyma, in which the central necrosis occurred. The cerebral abscess can originate through penetration of the infection at the inflammation of the surrounding structures (sinusitis, mastoiditis, thrombophlebitis, osteomyelitis of the cranial bones), hematogenic dissemination from another primary locus (infectious endocarditis, pneumonia), after injury, neurosurgical performance. Most frequently the cerebral abscess is caused by streptococci, anaerobic bacteria, enterobacteria and staphylococci. The clinical picture is variable. For diagnosis detection the imaging examinations as computed tomography (CT)) and magnetic resonance (MR) are decisive. The therapy consists of the long-term administration of antibiotics, symptomatic treatment, and neurosurgical intervention. Our case study describes a 73-year-old patient with a cerebral abscess caused by rare microorganism Nocardia transvalensis.<\/em><\/p>\n

    Keywords:<\/strong> Cerebral abscess, Nocardia<\/em> transvalensis<\/em><\/p>\n","casopis":[{"ID":2233,"post_author":"7","post_date":"2021-09-19 22:32:27","post_date_gmt":"2021-09-19 20:32:27","post_content":"We\u2019re bringing you this year\u2019s 1st<\/sup> issue of newslab, the scientific journal<\/strong>\r\n\r\n \r\n

      \r\n \t
    • Genomic variability of virus Sars-CoV-2<\/li>\r\n \t
    • Contribution of immunohistochemistry to histomorphological diagnostics of COVID-19 pneumonia<\/li>\r\n \t
    • Detection of microsatellite instability in Lynch syndrome-associated tumours<\/li>\r\n \t
    • Comparison of platelet glycoprotein analysis in the wholeh blood and plasma rich in platelets<\/li>\r\n \t
    • Tspan1 expression in prostatic adenocarcinoma<\/li>\r\n<\/ul>","post_title":"newslab","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"newslab-8","to_ping":"","pinged":"","post_modified":"2021-09-19 22:36:56","post_modified_gmt":"2021-09-19 20:36:56","post_content_filtered":"","post_parent":0,"guid":"https:\/\/www.newslab.sk\/casopis\/newslab-8\/","menu_order":0,"post_type":"casopis","post_mime_type":"","comment_count":"0","filter":"raw"}],"strana":"38 - 42","upload_clanok":{"ID":2289,"id":2289,"title":"NEWSLAB 1-2021_Babelova","filename":"NEWSLAB-1-2021_Babelova.pdf","filesize":1067960,"url":"https:\/\/www.newslab.sk\/wp-content\/uploads\/2021\/09\/NEWSLAB-1-2021_Babelova.pdf","link":"https:\/\/www.newslab.sk\/en\/nocardia-transvalensis-as-an-agent-causing-multifocal-cerebral-abscess-in-an-immunocompromised-patient\/newslab-1-2021_babelova-2\/","alt":"","author":"7","description":"","caption":"","name":"newslab-1-2021_babelova-2","status":"inherit","uploaded_to":2291,"date":"2021-09-20 08:54:10","modified":"2021-09-20 08:54:10","menu_order":0,"mime_type":"application\/pdf","type":"application","subtype":"pdf","icon":"https:\/\/www.newslab.sk\/wp-includes\/images\/media\/document.png"}},"_links":{"self":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/2291","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/comments?post=2291"}],"version-history":[{"count":0,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/2291\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/media?parent=2291"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/categories?post=2291"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/tags?post=2291"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}