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Background: Nocardia terpenica is an exceptionally rare opportunistic pathogen, with infections scarcely documented in clinical practice. We report the first case of primary brain abscess caused by Nocardia terpenica and present a comprehensive review of the microbiological features and clinical presentations associated with this pathogen.
Methods: The patient underwent intracranial puncture and drainage due to a brain abscess. During the procedure, cerebrospinal fluid (CSF) was collected for culture. The isolated pathogen was subjected to Gram staining and modified acid-fast staining. Identification was carried out using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). Susceptibility testing was performed using the microbroth dilution method.
Results: CSF culture on blood agar plates yielded small, white, agar-biting colonies. Gram staining revealed Gram-positive branching bacilli, and modified acid-fast staining was positive, suggesting Nocardia spp. MALDI-TOF MS (AnTu, China) confirmed Nocardia terpenica. Microbroth dilution susceptibility testing (35°C, 5 days) showed the isolate was susceptible to trimethoprim-sulfamethoxazole, minocycline, ciprofloxacin, moxifloxacin, clarithromycin, linezolid, tobramycin, amikacin, and imipenem, but resistant to ceftriaxone and amoxicillin-clavulanate. The patient was treated with linezolid, meropenem, and trimethoprim-sulfamethoxazole.
Conclusions: For patients with Nocardia terpenica infections, it is essential to identify the pathogen as early as possible and to provide adequate treatment for a sufficient duration.
DOI: 10.7754/Clin.Lab.2025.250708
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