skip to main content

Nocardia CNS Imaging — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

ModerateImmunocompromised HostNocardia CNS ImagingSCE Infectious Diseases

A 50-year-old man is diagnosed with a deep-seated abscess caused by Nocardia farcinica. He is started on IV Co-trimoxazole. What imaging of the CNS should be performed even in the absence of neurological symptoms?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — CT or MRI brain — CNS dissemination occurs in approximately 30% of systemic nocardiosis and may be asymptomatic initially

Nocardia disseminates haematogenously to the CNS in approximately 30% of systemic infections. CNS disease may be asymptomatic initially — brain abscesses can be clinically silent until large. Therefore, ALL patients with systemic nocardiosis (particularly those who are immunosuppressed) should have baseline CNS imaging (MRI preferred, CT acceptable) regardless of neurological symptoms. If CNS involvement is confirmed, treatment duration extends to 12 months minimum and may require addition of Imipenem or Linezolid for enhanced CNS penetration.

Reference: BSAC 2022 – Nocardiosis; BTS 2023 – Pulmonary nocardiosis