Cerebral nocardiosis in immunosuppressed patients: five cases.

Five cases of 'primary' cerebral nocardiosis are described. All occurred in patients already affected by factors carrying a poor prognosis for nocardial infections. These included primary immune dysfunction, immunosuppressive drug therapy including high-dose prednisolone and the presence of cerebral nocardial abscesses. Three of the five patients died, but only two had evidence of continued nocardial infection at necropsy. This compares with mortality of 90 per cent reported in other studies. Therefore aggressive surgical and antibiotic treatment of cerebral nocardial abscesses may reduce the mortality rate in the immunocompromised to the rate seen in immunocompetent patients. We suggest that investigations of non-specific pulmonary symptoms in the immunocompromised should include a search for nocardial colonization as this is indicative of infection. Diagnosis of nocardial infection at the pulmonary stage rather than when central nervous system abscesses are present would lead to an improvement in prognosis.