Absceso cerebral por Actinomyces sp: una infección infrecuente en niños: a propósito de un casot / Actinomyces sp. brain abscess: a rare infection in children: a case repor

A pesar de los avances en las técnicas de diagnóstico y tratamiento, las infecciones intracraneanas son aún enfermedades graves con una incidencia estimada entre 0,3 y 1,3 casos por cada 100 000 habitantes. Se presenta un paciente previamente sano con un absceso cerebral de diagnóstico intraoperatorio en quien, si bien el cultivo evidenció desarrollo polimicrobiano, se identificó presuntivamente Actinomyces sp. en la anatomía patológica. Dado este hallazgo, se realizó antibioticoterapia combinada prolongada con buena evolución. La presentación de este proceso supurado fue inespecífica y la contribución de la anatomía patológica en el diagnóstico etiológico fue relevante. La identificación de un microorganismo inhabitual definió la necesidad de profundizar en la determinación de factores predisponentes

Despite advances in diagnostic and treatment techniques, intracranial infections remain serious diseases with an estimated incidence of between 0.3 and 1.3 cases/100,000 inhabitants. We present a previously healthy patient with an intraoperative diagnostic of brain abscess, in whom although the culture showed polymicrobial development, Actinomyces sp was presumptively identified in the pathological anatomy. Given this finding, prolonged combined antibiotic therapy was performed with good evolution The presentation of this suppurative process was nonspecific and the contribution of the anatomopathology in the etiological diagnosis was relevant. The identification of an unusual microorganism defined the need to deepen the identification of predisposing factors.

Multiple Brain Abscesses Secondary to Odontogenic Infection: A Clinical Case Report

Introduction Cerebral abscess is a suppurative infection of the cerebral parenchyma, which may occur due to contiguity, hematogenous dissemination of distant foci, secondary to open traumatic brain injuries, or be idiopathic. Clinical Case A 63-year-old male patient sought assistance due to a severe headache in the frontal region associated with chills and lack of appetite that started four days before. Clinical examination of the patient showed no significant changes. Imaging and laboratory tests on admission showed only nonspecific changes, such as leukocytes 18,540, platelets 517,000, and c-reactive protein 2,0. In such case,magnetic resonance imaging (MRI) of the skull was performed with contrast, showing the presence of expansive lesions compatible with multiple brain abscesses in the right parietooccipital region. Discussion After excluding the main focus of hematogenous dissemination and in view of the identification of the agent Streptococcus intermedius by means of secretion culture collected through a surgical method, the hypothesis of abscess due to contiguous dental pyogenic foci was pointed out. Conclusion Dental evaluation showed multiple foci of infection with periodontitis and dental abscess, which were treated along with the use of antibiotics directed to the etiologic agent.

Absceso cerebral múltiple del lóbulo temporal derecho, reporte de un caso / Multiple brain abscess of the right temporary lobe, report of a case

RESUMEN El absceso cerebral es un proceso infeccioso focal del parénquima cerebral. Se inicia con un área localizada de cerebritis y progresa a una colección de pus rodeada por una cápsula bien vascularizada. La mortalidad oscila entre 5 a 15 % de los casos, excepto en la ruptura intraventricular del absceso cerebral, situación en que la mortalidad oscila entre 38 a 84 %, con tasas altas de discapacidad en los sobrevivientes. Se presentó un caso de 47 años, con sintomatología neurológica infecciosa, además de signos neurológicos que demuestran el trastorno funcional del lóbulo temporal no dominante. Se realizaron varios exámenes complementarios y se diagnosticó dos abscesos cerebrales temporales derechos. Fue intervenido neuroquirúrgicamente, su evolución fue satisfactoria con regresión de casi la totalidad de los síntomas prequirúrgicos presentados (AU).

ABSTRACT Brain abscess is a focal infectious process of the brain parenchyma. It begins with a located area of cerebritis and progresses to a pus collection surrounded by a well-vasculirized capsule. Mortality oscillates from 5 % to 15% of the cases, except in the intraventricular rupture of the brain abscess, situation in which mortality oscillates from 38 % to 84 %, with high rates of disability in survivors. The case presented is the case of a patient aged 47 years, with infectious neurologic symptoms besides neurologic signs showing the functional disorder of the non-dominant temporal lobe. Several complementary tests were carried out and two right temporal brain abscesses were diagnosed. The patient underwent a neurosurgery; his evolution was satisfactory with the almost total regression of the symptoms before surgery (AU).

Absceso cerebral causado por salmonella typhi: reporte de caso / Brain abscess caused by salmonella typhi: case report

Se presenta el caso de un paciente de 50 años de edad, quien es admitido a la emergencia de adultos, con cuadro un convulsivo asociado a fiebre de una semana de evolución. El estudio de tomografía cerebral reveló la presencia de imagen heterogénea en lóbulo frontal , se interviene quirúrgicamente con hallazgo de un absceso cerebral logrando el aislamiento de Salmonella typhi, cumple cuatro semanas de tratamiento con ceftriaxona intravenosa con mejoría tanto clínica como radiológica...(AU)

We present the case of a 50-year-old patient, who is admitted to the emergency of adults, with a convulsive symptoms associated with fever of one week of evolution. The cerebral tomography study revealed the presence of heterogeneous image in the frontal lobe, it was surgically intervened with the finding of a cerebral abscess achieving the isolation of Salmonella typhi, it was four weeks of treatment with intravenous ceftriaxone with clinical and radiological improvement ... (AU )

Diagnóstico diferencial entre Glioma y Absceso cerebrales: enseñanzas a partir de un caso / Differential diagnosis between Glioma and Abscess of the brain: teachings from a case

Development of neuroimaging in the last decades has revolutionized the neurological diagnosis, however for they interpretation clinical picture of the patient remains as a relevant aspect. Clinical case: a 30-year-old male patient with recent epileptic seizures, Jaksonian type, secondarily generalized, with no relevant history and normal neurological examination was presented. Initially a Magnetic Resonance of the brain was performed, the case was interpreted as Brain Abscess and treatment with intravenous antimicrobials was instituted for three weeks. A further analysis of the case revolves the diagnosis towards the possibility of a high degree malignant cerebral glioma, which was verified with the accomplishment of a craneotomy and biopsy. Conclusions: focal structural lesions of the brain, such as those caused by neuroepithelial tumors and abscesses, are among the most common causes of Epileptic Syndrome in adulthood. To date, there are no pathognomonic signs in the neuroimagenological differential diagnosis between the two entities. Despite the help of some advanced Magnetic Resonance techniques, the clinical correlation remains as the cornerstone for correct etiological interpretation, as well as pathological examination for the definitive diagnosis of both lesions.

Outcome of burr-hole aspiration of brain abscess

Objective: To determine the clinical outcome of burr-hole aspiration of brain abscess

Methods: We analyzed 100 cases of intracranial abscess, treated surgically from January 2015 and October 2016 at Jinnah Postgraduate Medical Centre [JPMC]. All patients were treated with burr hole aspiration. Medical records were analyzed for demographics, clinical presentation, predisposing factors, abscess location on imaging and clinical outcomes were charted

Results: The study included 100 patients with 73 [73%] males and 27[27%] females with a mean age of 36.69+10.96 years. Mean duration of signs and symptoms was 8.50+/-4.2 days. The most common presenting complaint was altered sensorium in 70 [70%] patients and commonest source of infection was otitis media een in 27 patients [27%]. The GCS on presentation was 13 in 57 [57%] cases. The parietal region was the most common site in 43 patients [43%], followed by frontal region in 33 patients [33%].Complete resolution of abscess with recovery of preoperative neuro-deficit was seen in 77 [77%] patients and recovery with major neuro-deficit was observed in 10 [10%] cases while 13 [13%] patients expired

Conclusion: Early diagnosis, optimum follow-up and timely burr-hole aspiration are the keys in the proper management of brain abscess

Management of brain abscess: Changing trend and experience in Enugu, Nigeria

Background: Intracranial abscess remains a significant health-care problem. Its causes, diagnosis, treatment, and outcome are changing. Aim: This paper reviewed the demography, examined new trends, and compared outcomes with different treatment options. Methodology: Retrospective analysis of intracranial abscesses managed at Memfys Hospital, Enugu (2004­2014) and University of Nigeria Teaching Hospital (2009­2014). Patients were followed up for at least 6 months. All patients had neuroimaging before intervention. Microscopy and culture were performed for the specimens. Intravenous antibiotics were given for 2 weeks before conversion to oral. Results: Seventy-nine parenchymal abscesses (eight cases per year) were managed. Peak age was the second decade of life. Previous head injury (21.5%) and meningitis (16.5%) were the most common predisposing factors. The frontal lobe was most common anatomical location (32%). Only 24% had positive culture result. Three cases were fungal infections. Seventy percent of patients managed with burr hole drainage and 37.5% of craniotomy made complete recovery. Overall, 58% of patients made complete recovery, whereas 19.0% died. Nine percent of cases died before definitive intervention. Among the 24% of patients that presented in coma, 47% died within 6 months. Most important factor influencing mortality was admission level of consciousness. Abscess recurred in 6% of cases. Conclusion: Intraparenchymal abscesses in Enugu were mostly solitary lesions resulting from poorly managed head injury and meningitis. Predisposition from otitis media and systemic diseases has reduced. The proportion of fungal organisms is increasing. A significant proportion of the patients present in coma. Burr hole and aspiration of abscess is less invasive and has very good outcome

Absceso cerebral por nocardia SP en paciente con anemia hemolítica reporte de un caso / Cerebral abscess due to nocardia SPP in a patient with hemolytic anemia report of a case

Las infecciones por Nocardia no son comunes para humanos inmunocompetentes la mayoría de casos es reportada en pacientes inmunosupresos, usualmente la mayoría de estos casos se reportan a nivel pulmonar y tejidos blandos. Los abscesos por Nocardia son usualmente poco comunes reportando aproximadamente el 1 a 2% del total de abscesos cerebrales. A continuación, se describe el caso de una paciente con antecedente de Anemia Hemolítica a quien se diagnosticó absceso cerebral por Nocardia...(AU)

Absceso cerebral en pacientes pediatricos / Brain abscess in pediatric patients

El absceso cerebral se constituye como un área central supurativa dentro del parénquima cerebral, dentro de una envoltura ampliamente vascularizada. Los patógenos ampliamente aislados en la patogénesis de esta entidad en niños son los Streptococos spp. A pesar del avance en la terapia antimicrobiana, las técnicas neuroquirúrgicas e imagenológicas, que permiten su diagnóstico y ubicación oportuna, el absceso cerebral aún se considera un problema de salud pública, con una importante incidencia, morbilidad y mortalidad en países en vía de desarrollo. Para el manejo de este tipo de infección del SNC, se requerirá de un abordaje multidisciplinario que involucre terapia médico quirúrgica. El objetivo de esta revisión es hacer un abordaje amplio sobre la patobiología del absceso cerebral relacionada con la labor concerniente al neurocirujano.

Brain abscess is formed as a central suppurativa area within the brain parenchyma, within an envelope extensively vascularized. Microorganisms largely isolated in the pathogenesis of this condition in children are Streptococos spp. Despite the progress in antimicrobial therapy, neurosurgical techniques and imagenologic support, which enabling timely diagnosis and location, brain abscess is still considered a public health problem and has an important incidence, morbidity and mortality in developing countries. To handle this type of CNS infection, will require a multidisciplinary approach involving surgical medical therapy. The aim of this review is to make a comprehensive approach on the pathobiology of brain abscess related to the work concerning the neurosurgeon.

Absceso cerebral en lactante: caso clínico y revisión de la literatura / Infant brain abscess: case report and literature review

El absceso cerebral concierne a una colección de pus localizada en el parénquima cerebral. Es muy poco frecuente en los niños lactantes, predominando en los jóvenes y personas de edad avanzada. Esta entidad se presenta con manifestaciones clínicas muy variable. Los agentes etiológicos son muy diversos pero predominan los Streptococos, Staphylococcus y la klebsiella. El diagnóstico se basa en el cuadro clínico, el examen físico y los complementarios. El tratamiento se adecua al estadio en el que se encuentre la lesión inflamatoria, el germen que la produzca, el tamaño de la lesión y la condición neurológica del paciente. En el presente trabajo se presenta un lactante de 4 meses de edad con antecedentes de haber tenido una infección respiratoria alta tres meses previos a su ingreso que un mes después comenzó con fiebre de 38-39° C asociado a irritabilidad y fontanela anterior ocupada, en la tomografía contrastada se evidenció imagen hipodensa en región frontal izquierda con gran efecto de masa y desplazamiento de las estructuras de la línea media. Fue puncionado dos días consecutivos donde se evacuaron 80 ml de pus amarillento, en cada proceder al 4to día se interviene quirúrgicamente con craneotomía frontotemporal izquierda y lobectomía frontal ipsilateral con resección de toda la cápsula. Se le mantuvo con tratamiento antibiótico por 3 semanas. En la resonancia magnética postoperatoria hubo una desaparición de los signos inflamatorios del encéfalo, su evolución posterior fue satisfactoria.

A cerebral abscess is defined as a collection of pus within the cerebral parenchyma. Though rare in infants, it is common among young patients and the elderly. The clinical manifestations are varied. The predominant etiological agents include Streptococci, staphylococci and klebsiella. A patient is diagnosed based on the clinical picture, the physical exam and complementary tests. Treatment options depend on the stage of the disease, its size, the causative agent, and the neurological condition of the patient. A case is presented of a four month old infant with a history of an upper respiratory tract infection three months prior to his admission. One month later, he exhibited a high fever of 38-39 °C with irritability and a tense anterior fontanel. The CT scan revealed a hypo dense lesion in the left frontal lobe with significant mass effect and midline shift. The lesion was punctured on two consecutive days and 80 ml of yellowish pus was removed on both occasions. Four days later, a left fronto-temporal craniotomy and an ipsilateral frontal lobectomy was performed, with complete excision of the capsule. Antibiotic therapy was continued for three weeks. The post op MRI confirmed the complete excision of the lesion and disappearance of the surrounding edema. Recovery was satisfactory

Nocardiosis cerebral parvosintomática, en pacientes inmunocomprometidos / Parvosymptomatic cerebral nocardiosis in immunocompromised patients

Antecedentes: La nocardiosis es originada por distintas cepas de Nocardia, bacterias Gram positivas que afecta a humanos y animales. Pueden producir infecciones sistémicas de ingreso cutáneo o pulmonar, que llegan a comprometer el Sistema Nervioso Central. Se afectan especialmente pacientes inmunosuprimidos que pueden desarrollar abscesos cerebrales, visibles en la Resonancia Magnética (RM), pero que no expresan síntomas de las lesiones focales o son parvosintomáticos. Pacientes y Método: Queremos comunicar dos mujeres con trasplante renal en tratamiento inmunosupresor, que desarrollaron cuadros pulmonares agudos que obligaron a su hospitalización, en cuyo contexto la paciente (A) presentó una convulsión y la (B) cefalea y compromiso de conciencia, que obligaron a una RM de cerebro. En ambos casos se encontraron múltiples abscesos cerebrales de distinta ubicación y tamaño que no habían dado síntomas focales. La nocardiosis se identificó en la paciente (A) con la biopsia de un micetoma cutáneo y en la (B) con la resolución quirúrgica de un absceso cerebeloso. En ambas se inició tratamiento específico con adecuada respuesta. Sin embargo, las reacciones adversas a la antibioterapia obligaron a suspenderla. Esta suspensión reactivó la infección que complicó y llevó al fallecimiento de las pacientes. Conclusiones: La publicación de varios casos de nocardiosis cerebral parvosintomática en pacientes inmunosuprimidos sugiere que para las infecciones cerebrales por Nocardia la pérdida de la inmunidad celular resulta muy significativa, porque permitiría el ingreso y proliferación de la bacteria al interior del SNC sin generar respuestas clínicas inmediatas. La aparición de síntomas se relacionaría con una tardía alteración de la barrera hematoencefálica, más que con el lento proceso lesional de la Nocardia. Lo que condicionaría su diagnóstico oportuno.

Background: Nocardiosis is caused by several strains of Nocardia, Gram-positive bacteria that infects humans and animals likewise. They develop a systemic infection of pulmonary or cutaneous origin that can spread to the Central Nervous System. It frequently affects immunosupresed patients, in which parvosymptomatic cerebral abscess has been described, visible in magnetic resonance imaging but without focal symptoms. Patients and Methods: We want to communicate two women with renal transplant in immunosupresor treatment who were admitted to our hospital for acute pulmonar disease, during which patient A presented a convulsive episode and patient B headache and stupor, after which CT and MR were obtained. In both cases multiple cerebral abscesses were found, of different sizes and location, with no clinical manifestations. Nocardia diagnosis was made in patient A by biopsy from a cutaneous mycetoma and in patient B after surgery of a cerebellar abscess. In both cases antimicrobial treatment was initiated with good response, but had to be interrupted due to adverse effects. This reactivated the infection, which had a complicated course and finally lead to the death of both patients. Conclusions: The fact that several cases of parvosymtomatic cerebral Nocardiosis in immunosupresed patients have been published suggest that cellular immunosupresion is key in the development of cerebral infections by Nocardia. It probably allows the access and multiplication of the bacteria inside the encephalon without an immediate clinical response. The development of symptoms is probably related to a late alteration of the blood-brain barrier rather than to the slow progression of Nocardia disease.

Application of 31P MR Spectroscopy to the Brain Tumors

OBJECTIVE: To evaluate the clinical feasibility and obtain useful parameters of 31P magnetic resonance spectroscopy (MRS) study for making the differential diagnosis of brain tumors. MATERIALS AND METHODS: Twenty-eight patients with brain tumorous lesions (22 cases of brain tumor and 6 cases of abscess) and 11 normal volunteers were included. The patients were classified into the astrocytoma group, lymphoma group, metastasis group and the abscess group. We obtained the intracellular pH and the metabolite ratios of phosphomonoesters/phosophodiesters (PME/PDE), PME/inorganic phosphate (Pi), PDE/Pi, PME/adenosine triphosphate (ATP), PDE/ATP, PME/phosphocreatine (PCr), PDE/PCr, PCr/ATP, PCr/Pi, and ATP/Pi, and evaluated the statistical significances. RESULTS: The brain tumors had a tendency of alkalization (pH = 7.28 +/- 0.27, p = 0.090), especially the pH of the lymphoma was significantly increased (pH = 7.45 +/- 0.32, p = 0.013). The brain tumor group showed increased PME/PDE ratio compared with that in the normal control group (p = 0.012). The ratios of PME/PDE, PDE/Pi, PME/PCr and PDE/PCr showed statistically significant differences between each brain lesion groups (p < 0.05). The astrocytoma showed an increased PME/PDE and PME/PCr ratio. The ratios of PDE/Pi, PME/PCr, and PDE/PCr in lymphoma group were lower than those in the control group and astrocytoma group. The metastasis group showed an increased PME/PDE ratio, compared with that in the normal control group. CONCLUSION: We have obtained the clinically applicable 31P MRS, and the pH, PME/PDE, PDE/Pi, PME/PCr, and PDE/PCr ratios are helpful for differentiating among the different types of brain tumors.

Importância do diagnóstico presuntivo de abscessos encefálicos no sistema nervoso central / Importance of presumptive diagnosis of encefalic abscess in central nervous system

Introdução: Abscessos cerebrais são caracterizados por uma coleção de exsudato no parênquima encefálico capazes de acometer indivíduos de qualquer idade, raça e sexo. Atençãoespecial deve ser dada a esses casos, pois sua apresentação clínica pode simular outros agravos, tornando importante ampliar o raciocínio para diversos diagnósticos diferenciais. O presente estudo visa o relato de caso de uma paciente admitida na Santa Casa de Misericórdia de Sobral com quadro sugestivo de cefaléia secundária. Material e Métodos: MEMA, 22 anos,universitária, evoluiu em 11 dias com cefaléia unilateral em região frontal esquerda e pulsátil. Essa cefaléia tinha caráter habitual, apresentava intensidade progressiva, associava-se a náuseas, melhorava com repouso e analgésicos, não havendo relato defator desencadeante. Resultados: O exame neurológico evidenciou alteração no estado mental, com déficit de memória imediata e recente, compreensão e nomeação; além de desorientação temporo-espacial. Observou-se na Tomografia Computadorizada de Crânio (TCC) uma imagem hipodensa temporal esquerda,com halo hiperdenso de reforço após administração de contraste. Conclusão: A mortalidade nos pacientes com abscesso cerebral pode variar entre 10-40%, sendo bastante influenciada pelo estado clínico dos pacientes na admissão. Os sinais de alerta da cefaléia, também conhecidos como red flags, são de alto valor preditivo para agravos secundários cerebrais e devem ser considerados pelos profissionais de saúde que atuam em serviço de prontoatendimento. A TCC é uma importante ferramenta de diagnóstico e de avaliação dos abscessos cerebrais, sendo sua precocidade de realização fator prognóstico decisivo para o paciente.

Introduction: Brain abscesses are characterized by a exudate collection in the brain parenchyma able to reachindividuals of any age, race and sex. Special attention should be given to these cases because their clinical presentation may mimic other diseases, making it important to extend the reasoning of possible differential diagnoses. This study is a case of a patient admitted to the Santa Casa de Misericórdia de Sobral with cluessuggestive of secondary headache. Methods: MEMA, 22 years, university, developed in eleven days unilateral headache in the left frontal region and pulsatile. The headache was of normal character, intensity was progressive, associated to nausea, improves withrest and analgesics and no reports of triggering factor. Results: Neurological examination revealed changes in mental status, with lack of immediate and recent memory, understanding and naming, in addition to temporo-spatial disorientation. It was observed in CT scan of skull (CTS) a left temporal hypodense image with hyperdense halo of enhancement after administration of contrast. Conclusion: The mortality in patients with brain abscess can varybetween 10-40% and is strongly influenced by the clinical status of patients on admission. The warning signs of a headache, also known as red flags, are of high predictive value for secondary brain injuries and should be considered by health professionals who work in service of the emergency room. The CTS is an important tool for diagnosis and assessment of brain abscesses, and its early implementation of decisive prognostic factor for patients.

A Case of Brain Abscess Caused by Propionibacterium acnes 13 Months after Neurosurgery and Confirmed by 16S rRNA Gene Sequencing / 대한진단검사의학회지

Propionibacterium acnes is a gram-positive anaerobic bacillus and a normal inhabitant of the skin. Although it is often considered a contaminant of blood cultures, it can occasionally cause serious infections, including postoperative central nervous system infections. Here, we report the case of a 70-yr-old man who developed a large cerebral abscess caused by P. acnes 13 months after neurosurgery. Immediate gram staining of the pus from his brain revealed the presence of gram-positive coccobacilli. However, colony growth was observed only after 5 days of culture. Therefore, we performed 16S rRNA gene sequencing of the pus specimen. The isolate was identified as P. acnes. The colonies developed 9 days after the initial culture. The API Rapid ID 32A test (bioMerieux, France) was performed using a colony, but an unacceptable profile was obtained. Then, the pus was transferred into the enrichment broths of the BACTEC FX (Becton Dickinson, USA) and BacT/Alert 3D (bioMerieux, Organon Teknika, USA) systems, but only the BACTEC FX system could detect growth after 5 days. We performed 16S rRNA gene sequencing and API Rapid 32A profiling with a colony recovered from Brucella agar, which was inoculated with the microbial growth in the enrichment broth from the BACTEC FX system. The organism was identified as P. acnes by both methods. This case suggests that 16S rRNA gene sequencing may be a useful alternative for identifying slowly growing P. acnes from specimens that do not show growth after 5 days of culture.

Chronic brain abscess secondary to a retained wooden foreign body: Diagnostic and management dilemmas.

A four-year-old child presented with recent onset generalized tonic clonic seizures. She was operated for a suspected intracranial tuberculoma and was found to harbor an intra-parenchymal retained wooden foreign body with a chronic abscess. The foreign body had entered the brain parenchyma after a minor head injury, sustained three years earlier. She was asymptomatic for the intervening three years. The initial diagnosis was missed by several physicians. A retained wooden fragment via a transtemporal apparently closed head injury is an extremely rare event. The present study reveals the diagnostic and therapeutic challenges and stresses the importance of high degree of suspicion to diagnose retained intracranial foreign bodies and the need for early surgical exploration, to avoid chronic and potentially life threatening neurological complications.

Disseminated tuberculosis presenting as mesenteric and cerebral abscess in HIV infection: case report

Disseminated tuberculosis in HIV infection involves multiple organs. Pulmonary and lymph node involvement are the commonest form of tuberculosis in HIV infection [1, 2]. Other forms of tuberculosis in the absence of lung and lymph node involvement are rare. Various forms of abdominal [3, 4] and neurological [5, 6] tubercular involvement in HIV infection have been reported. But tuberculosis presenting simultaneously with mesenteric and brain abscess has not been reported yet. We report a case of disseminated tuberculosis presenting as mesenteric and cerebral abscess in a HIV case without involving lung and lymph nodes. Bone marrow smears and fine needle aspiration cytology (FNAC) from mesenteric lesion were positive for acid fast bacilli (AFB) and the diagnosis of tuberculosis was confirmed by positive polymerase chain reaction (PCR). He responded well to treatment with anti tubercular drugs.

Nocardia brain abscess: a case report

Nocardiosis infections are rare, generally systemic, an occurring at the immuno compromised patient. The cerebral abscess with Nocardia is usually secondary to a pulmonary localization. Their bacteriological diagnosis and therapeutic management could be difficult. We report a case of cerebral abscess due to Nocardia in 47 years old patient treated with corticoids for a pulmonary confirmed sarcoidosis. He was hospitalized for a clinical feature in favour of an intra cranial expansive process. The diagnosis of Nocardiosis was suspected at direct examination of Gram stained smears and confirmed by the culture characteristics. The evolution was favorable after stereotaxic punction of the abscess and adapted antibiotherapy based on disc diffusion antibiogram. This observation emphasizes the interest of the bacteriological diagnosis for correct management of cerebral abscesses