Primary Nocardia farcinica Brain Abscess With Secondary Relapsing Meningitis in an Immunocompromised Patient
Bibliographic record
Abstract
Nocardiosis is an opportunistic infection primarily affecting immunocompromised patients. Central nervous system (CNS) involvement in the form of cerebral abscesses may be a complication of nocardia infection. Nocardia farcinica , in particular, is believed to disseminate the CNS more often than other nocardia species, being associated with antibiotic resistance and therefore higher mortality. We describe the first case of a patient with relapsing meningitis caused by N. farcinica . A 61-year-old Caucasian man was admitted for evaluation of fever, headache and confusion. Magnetic resonance imaging of the brain revealed cerebral abscesses and examination of the cerebrospinal fluid (CSF), polymorphonuclear count, elevated protein and hypoglycorrhachia. CSF cultures were negative, while multiplex polymerase chain reaction showed Staphylococcus aureus . The patient received vancomycin/meropenem and later, because he was still febrile, with symptoms from the CNS, linezolid/meropenem, in which he responded well. During the following months, he had to discontinue linezolid because of myelosuppression with subsequent relapses of meningitis. In such a relapse, the patient was admitted for reevaluation. CNS cultures grew N. farcinica , susceptible to linezolid, trimethoprim/sulfamethoxazol and ceftriaxone. He was discharged on trimethoprim/sulfamethoxazole for 12 months. This is the first reported case of relapsing meningitis caused by N. farcinica . It highlights, on the one hand, the importance of the prolonged treatment in relapse’s prevention and on the other, the limited value of linezolid as prolonged treatment due to its long-term toxicities. J Med Cases. 2015;6(7):304-306 doi: http://dx.doi.org/10.14740/jmc2157w
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".