1887

Abstract

Standard culture methods may fail to detect the causative agents of bacterial infection for various reasons including specimen collection after antibiotic administration, or when standard techniques or environmental conditions are not appropriate for growth of the microorganisms. Conventional 16S rRNA gene sequencing is sometimes a useful alternative technique for identification of bacteria, but is confounded by polymicrobial infection. We present a case of a patient who developed a serious neurological infection for which causative oral flora organisms were observed by microscopy, failed to culture but were identified by next-generation DNA sequencing.

A male in his forties developed sinus pain and congestion, followed by facial and eye pain, and several weeks later acute-onset confusion and neck stiffness. Cerebrospinal fluid examination revealed pleocytosis and several bacterial morphologies, which were subsequently identified by next-generation sequencing as oral flora constituents , , , species and .

Oral flora can cause meningoencephalitis and brain abscess formation if translocation occurs by injury or surgical procedures. Next-generation sequencing is often not available at healthcare facilities, or when available may not have been validated for a wide spectrum of specimen sources, but is available at reference laboratories and should be considered when routine methods fail to provide a diagnosis for serious infections.

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2019-08-19
2019-09-18
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References

  1. Thigpen MC, Whitney CG, Messonnier NE, Zell ER, Lynfield R et al. Bacterial meningitis in the United States, 1998-2007. N Engl J Med 2011;364:2016–2025 [CrossRef]
    [Google Scholar]
  2. Castelblanco RL, Lee M, Hasbun R. Epidemiology of bacterial meningitis in the USA from 1997 to 2010: a population-based observational study. Lancet Infect Dis 2014;14:813–819 [CrossRef]
    [Google Scholar]
  3. New DW. Meningitis caused by Porphyromonas endodontalis detected by PCR amplification and sequencing of 16S rRNA genes direct from cerebrospinal fluid and cerebral tissue JMM Case Reports. 2015
  4. Keller PM, Rampini SK, Bloemberg GV. Detection of a mixed infection in a culture-negative brain abscess by broad-spectrum bacterial 16S rRNA gene PCR. J Clin Microbiol 2010;48:2250–2252 [CrossRef]
    [Google Scholar]
  5. Ko J-H, Baek JY, Kang C-I, Lee WJ, Lee JY et al. Bacteremic meningitis caused by Parvimonas micra in an immunocompetent host. Anaerobe 2015;34:161–163 [CrossRef]
    [Google Scholar]
  6. Veldhoen ES, Wolfs TF, van Vught AJ. Two cases of fatal meningitis due to Fusobacterium necrophorum. Pediatr Neurol 2007;36:261–263 [CrossRef]
    [Google Scholar]
  7. Roca B, Romero A, Simón E. Acute meningitis caused by Streptococcus constellatus. J Infect 1998;37:88 [CrossRef]
    [Google Scholar]
  8. García-Lechuz JM, Hernangómez S, San Juan R, Bouza E. Feculent meningitis: polymicrobial meningitis in colorectal surgery. Diagn Microbiol Infect Dis 2000;38:169–170 [CrossRef]
    [Google Scholar]
  9. Chun C, Sacks B, Jao J. Polymicrobial feculent meningitis. Clin Infect Dis 1995;21:693–694 [CrossRef]
    [Google Scholar]
  10. Salipante SJ, Hoogestraat DR, Abbott AN, SenGupta DJ, Cummings LA et al. Coinfection of Fusobacterium nucleatum and Actinomyces israelii in mastoiditis diagnosed by next-generation DNA sequencing. J Clin Microbiol 2014;52:1789–1792 [CrossRef]
    [Google Scholar]
  11. Salipante SJ, Sengupta DJ, Rosenthal C, Costa G, Spangler J et al. Rapid 16S rRNA next-generation sequencing of polymicrobial clinical samples for diagnosis of complex bacterial infections. PLoS One 2013;8:e65226 [CrossRef]
    [Google Scholar]
  12. Zaura E, Keijser BJF, Huse SM, Crielaard W. Defining the healthy "core microbiome" of oral microbial communities. BMC Microbiol 2009;9:259 [CrossRef]
    [Google Scholar]
  13. Chen T, Tu WH, Izard J, Baranova OV, Lakshmanan A et al. The human oral microbiome database: a web accessible resource for investigating oral microbe taxonomic and genomic information. Database 2010;2010, baq013
    [Google Scholar]
  14. Dewhirst FE, Chen T, Izard J, Paster BJ, Tanner ACR et al. The human oral microbiome. J Bacteriol 2010;192:5002–5017 [CrossRef]
    [Google Scholar]
  15. Santos AL, Siqueira JF, Rôças IN, Jesus EC, Rosado AS et al. Comparing the bacterial diversity of acute and chronic dental root canal infections. PLoS One 2011;6:e28088 [CrossRef]
    [Google Scholar]
  16. Machado de Oliveira JC, Siqueira JF, Alves GB, Hirata R, Andrade AF. Detection of Porphyromonas endodontalis in infected root canals by 16S rRNA gene-directed polymerase chain reaction. J Endod 2000;26:729–732 [CrossRef]
    [Google Scholar]
  17. Signat B, Roques C, Poulet P, Duffaut D. Fusobacterium nucleatum in periodontal health and disease. Curr Issues Mol Biol 2011;13:25–36
    [Google Scholar]
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