N. brasiliensis typically causes cutaneous and lymphocutaneous disease, but it may also cause systemic and, occasionally, central nervous system infection. Immunocompromise is a well-established risk factor for nocardiosis. The diagnosis is often missed or delayed because of the lack of clinical and laboratory signs of bacterial infection, and silent invasion and persistence make diagnosis and management difficult. Therefore, cerebral biopsy should be undertaken promptly in an immunocompromised patient because of the potential implications for treatment 1 . The choice and dose of antimicrobial drugs and the duration of therapy depends on the extent of infection, underlying host factors, the species of Nocardia , and the clinical response to initial management.
Sulfonamides are the treatment of choice for nocardiosis.
As primary therapy, parenteral combinations containing imipenem, amikacin, and a third-generation cephalosporin should be considered experimental until further data are available. One author has suggested that surgery should be performed in patients with cerebral abscesses due to Nocardia spp . Although decompression of lesions may be accomplished by stereotactic aspiration, in some cases cure in is effected only after craniotomy and total excision 3 . Small abscesses can be cured by prolonged antimicrobial therapy. Because abscesses may progress in the face of appropriate therapy, all patients should be monitored frequently with cranial computed tomography or other imaging modalities 4 .