{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T22:51:13Z","timestamp":1789771873105,"version":"4.0.1"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>\n                    Brain abscess is a suppurative infection of brain tissue caused by one or more pathogens under specific susceptible conditions and is associated with a high clinical fatality rate. Beyond surgical intervention, the identification of pathogens is key to clinical antimicrobial therapy, yet this remains a challenge.\n                    <jats:italic>Nocardia<\/jats:italic>\n                    is a ubiquitous bacterium that typically manifests as an opportunistic infection, primarily affecting immunocompromised individuals. Pulmonary involvement, characterized by suppurative inflammation, commonly occurs following inhalation, with subsequent hematogenous dissemination potentially leading to widespread infection. To our knowledge, central nervous system (CNS) infection by\n                    <jats:italic>Nocardia asiatica<\/jats:italic>\n                    (\n                    <jats:italic>N. asiatica<\/jats:italic>\n                    ) resulting in brain abscess has hitherto rarely been reported. We present a rare case of multiple brain abscesses caused by\n                    <jats:italic>N. asiatica<\/jats:italic>\n                    co-infection with Torque teno virus (TTV) in an immunocompetent patient with suspected multiple organ involvement. The patient was admitted to our hospital, presenting with a headache, and imaging revealed brain abscess-like lesions. A robot-assisted stereotactic puncture and drainage were used for abscess removal.\n                    <jats:italic>N. asiatica<\/jats:italic>\n                    and TTV were identified by metagenomic next-generation sequencing (mNGS) of the brain abscess aspirate, with\n                    <jats:italic>N. asiatica<\/jats:italic>\n                    subsequently confirmed by mass spectrometry of the cultured organism. A disseminated\n                    <jats:italic>Nocardia<\/jats:italic>\n                    infection was suspected based on the patient\u2019s skin trauma history, pulmonary inflammatory changes, and imaging findings (liver cysts, subcutaneous nodules). However, etiological confirmation was not obtained prior to his death. While this is not the first reported instance of\n                    <jats:italic>Nocardia<\/jats:italic>\n                    and TTV co-infection in brain abscesses, our case is notable for its occurrence in an immunocompetent patient. This report highlights the significance and value of TTV in the context of brain abscesses and warrants a re-evaluation of\n                    <jats:italic>Nocardia<\/jats:italic>\n                    and TTV co-infection. Given that the diagnosis of intracranial infection depends on the detection of pathogens, we advocate for the routine and early implementation of mNGS testing in patients with brain abscesses. Moreover, systemic nutritional support and immunomodulatory therapies should be considered in the early stage of treatment for complex cases. Earlier diagnosis and treatment in this case might have altered the patient\u2019s outcome.\n                  <\/jats:p>","DOI":"10.3389\/fmed.2025.1661345","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T05:20:13Z","timestamp":1762924813000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Multiple brain abscesses caused by Nocardia asiatica co-infection with Torque teno virus in an \u201cimmunocompetent\u201d patient: a rare case report and literature review"],"prefix":"10.3389","volume":"12","author":[{"given":"Weiwei","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Ran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuoxin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinbo","family":"Yin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengqing","family":"Lv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guolong","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuchun","family":"Pei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1159\/000110257","article-title":"Incidence and prognosis of brain abscess in a defined population: Olmsted County, Minnesota, 1935\u20131981","volume":"10","author":"Nicolosi","year":"1991","journal-title":"Neuroepidemiology"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1097\/qco.0000000000001014","article-title":"Update and approach to patients with brain abscess","volume":"37","author":"Omland","year":"2024","journal-title":"Curr Opin Infect Dis"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1056\/NEJMra1301635","article-title":"Brain abscess","volume":"371","author":"Brouwer","year":"2014","journal-title":"N Engl J Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1080\/14787210.2018.1489722","article-title":"Anti-infective treatment of brain abscess","volume":"16","author":"Bodilsen","year":"2018","journal-title":"Expert Rev Anti-Infect Ther"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1016\/j.mayocp.2011.11.016","article-title":"Nocardiosis: updates and clinical overview","volume":"87","author":"Wilson","year":"2012","journal-title":"Mayo Clin Proc"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e53","DOI":"10.1093\/cid\/ciae643","article-title":"State-of-the-art review: modern approach to Nocardiosis\u2014diagnosis, management, and uncertainties","volume":"80","author":"Yetmar","year":"2025","journal-title":"Clin Infect Dis"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1093\/qjmed\/hcy073","article-title":"Nocardia: a rare cause of brain abscess","volume":"111","author":"Radhakrishnan","year":"2018","journal-title":"QJM"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1227\/00006123-199410000-00007","article-title":"Nocardial brain abscess","volume":"35","author":"Mamelak","year":"1994","journal-title":"Neurosurgery"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1006\/bbrc.1997.7765","article-title":"A novel DNA virus (TTV) associated with elevated transaminase levels in Posttransfusion hepatitis of unknown etiology","volume":"241","author":"Nishizawa","year":"1997","journal-title":"Biochem Biophys Res Commun"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"6044","DOI":"10.3748\/wjg.14.6044","article-title":"Torque Teno virus: its prevalence and isotypes in North India","volume":"14","author":"Irshad","year":"2008","journal-title":"World J Gastroenterol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"277","DOI":"10.3390\/v14061277","article-title":"Torque Teno virus primary infection kinetics in early childhood","volume":"14","author":"V\u00e4is\u00e4nen","year":"2022","journal-title":"Viruses"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"998","DOI":"10.3389\/fimmu.2020.00998","article-title":"Torque Teno virus as a potential biomarker for complications and survival after allogeneic hematopoietic stem cell transplantation","volume":"11","author":"Pradier","year":"2020","journal-title":"Front Immunol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"744","DOI":"10.3390\/ijms25147744","article-title":"Torque Teno virus: a promising biomarker in kidney transplant recipients","volume":"25","author":"Dal Lago","year":"2024","journal-title":"Int J Mol Sci"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1002\/jmv.2051","article-title":"Low prevalence of TT virus in the cerebrospinal fluid of viremic patients with central nervous system disorders","volume":"65","author":"Maggi","year":"2001","journal-title":"J Med Virol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e02196","DOI":"10.1016\/j.idcr.2025.e02196","article-title":"A children patient with intracranial infection after brain surgery associated with elevated torque Teno virus","volume":"40","author":"Wang","year":"2025","journal-title":"IDCases"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1212\/wnl.0000000000000172","article-title":"Clinical characteristics and outcome of brain abscess","volume":"82","author":"Brouwer","year":"2014","journal-title":"Neurology"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e1008280","DOI":"10.1371\/journal.ppat.1008280","article-title":"Pathogenic Nocardia: a diverse genus of emerging pathogens or just poorly recognized?","volume":"16","author":"Mehta","year":"2020","journal-title":"PLoS Pathog"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1128\/cmr.7.2.213","article-title":"Nocardia species: host-parasite relationships","volume":"7","author":"Beaman","year":"1994","journal-title":"Clin Microbiol Rev"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2012\/325767","article-title":"First report of Nocardia asiatica presenting as an anterior mediastinal mass in a patient with myasthenia gravis: a case report and review of the literature","volume":"2012","author":"El-Herte","year":"2012","journal-title":"Case Rep Infect Dis"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"459","DOI":"10.3343\/alm.2017.37.5.459","article-title":"Multiple brain abscesses caused by Nocardia asiatica in a patient with systemic lupus erythematosus: the first case report and literature review","volume":"37","author":"Jeong","year":"2017","journal-title":"Ann Lab Med"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.jiph.2018.12.008","article-title":"Disseminated Nocardia asiatica infection in an immunocompromised individual: a rare entity needs careful vigilance","volume":"12","author":"Banerjee","year":"2019","journal-title":"J Infect Public Health"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1232","DOI":"10.4103\/jfmpc.jfmpc_1005_19","article-title":"Isolated cerebellar abscess by Norcardia asiatica: a case report with review of literature","volume":"9","author":"Srivastava","year":"2020","journal-title":"J Family Med Prim Care"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1111\/ene.14533","article-title":"Rapid and accurate diagnosis of brain abscess caused by Nocardia asiatica with a combination of Ziehl-Neelsen staining and metagenomics next-generation sequencing","volume":"28","author":"Huang","year":"2020","journal-title":"Eur J Neurol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e6816","DOI":"10.1002\/ccr3.6816","article-title":"Brain abscess due to Nocardia asiatica in a 63-year-old patient with adult-onset still disease: a case report","volume":"11","author":"Salazar Reinoso","year":"2023","journal-title":"Clin Case Reports"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e01903","DOI":"10.1016\/j.idcr.2023.e01903","article-title":"Multiple brain abscesses caused by Nocardia asiatica: case report and literature review","volume":"34","author":"Jin","year":"2023","journal-title":"IDCases"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"7862","DOI":"10.1038\/srep17862","article-title":"Genetic diversity and antimicrobial susceptibility of Nocardia species among patients with nocardiosis","volume":"5","author":"Hashemi-Shahraki","year":"2015","journal-title":"Sci Rep"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"579","DOI":"10.3390\/pathogens10050579","article-title":"Isolation and characterization of Nocardiae associated with foaming coastal marine waters","volume":"10","author":"Wright","year":"2021","journal-title":"Pathogens"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1186\/s12879-020-05052-0","article-title":"A clinical case report of brain abscess caused by Nocardia brasiliensis in a non-immunocompromised patient and a relevant literature review","volume":"20","author":"Zhu","year":"2020","journal-title":"BMC Infect Dis"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1128\/cmr.19.2.259-282.2006","article-title":"Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy","volume":"19","author":"Brown-Elliott","year":"2006","journal-title":"Clin Microbiol Rev"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.cmi.2023.08.016","article-title":"European society of clinical microbiology and infectious diseases guidelines on diagnosis and treatment of brain abscess in children and adults","volume":"30","author":"Bodilsen","year":"2024","journal-title":"Clin Microbiol Infect"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"E18","DOI":"10.3171\/2019.5.Focus19284","article-title":"Nocardia amikacinitolerans and cytomegalovirus: distinctive clinical and radiological characterization of the rare etiologies of brain abscesses: report of 2 cases","volume":"47","author":"Quinoa","year":"2019","journal-title":"Neurosurg Focus"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"107147","DOI":"10.1016\/j.micpath.2024.107147","article-title":"Multicenter systematic review of clinical characteristics, diagnostic optimization, and personalized treatment for brain Nocardia infections","volume":"198","author":"Shen","year":"2025","journal-title":"Microb Pathog"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1038\/s41576-019-0113-7","article-title":"Clinical metagenomics","volume":"20","author":"Chiu","year":"2019","journal-title":"Nat Rev Genet"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"112024","DOI":"10.1016\/j.mad.2024.112024","article-title":"The effect of torque Teno virus (TTV) infection on clinical outcomes, genomic integrity, and mortality in COPD patients","volume":"224","author":"Russo","year":"2025","journal-title":"Mech Ageing Dev"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1371\/journal.ppat.0010041","article-title":"Recognition of conserved amino acid motifs of common viruses and its role in autoimmunity","volume":"1","author":"Sospedra","year":"2005","journal-title":"PLoS Pathog"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"177","DOI":"10.3390\/ijms252011177","article-title":"Torque Teno virus (TTV) infection in patients with encephalitis","volume":"25","author":"Jurasz","year":"2024","journal-title":"Int J Mol Sci"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1007\/s12250-017-4042-3","article-title":"Identification of a novel torque Teno mini virus in cerebrospinal fluid from a child with encephalitis","volume":"32","author":"Kang","year":"2017","journal-title":"Virol Sin"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"3093","DOI":"10.1177\/03000605251363093","article-title":"Intracranial infection caused by Streptococcus intermedius and torque Teno virus: a case report","volume":"53","author":"Zhou","year":"2025","journal-title":"J Int Med Res"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"e28632","DOI":"10.1016\/j.heliyon.2024.e28632","article-title":"Nocardia farcinica brain abscess with torque Teno virus co-infection: a case report","volume":"10","author":"Gu","year":"2024","journal-title":"Heliyon"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"3522","DOI":"10.1038\/s41591-024-03275-1","article-title":"Seven-year performance of a clinical metagenomic next-generation sequencing test for diagnosis of central nervous system infections","volume":"30","author":"Benoit","year":"2024","journal-title":"Nat Med"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1661345\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T05:20:15Z","timestamp":1762924815000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1661345\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,12]]},"references-count":40,"alternative-id":["10.3389\/fmed.2025.1661345"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1661345","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,12]]},"article-number":"1661345"}}