[A case of culture-negative brain abscess caused by Streptococcus intermedius infection diagnosed by broad-range PCR of 16S ribosomal RNA].

Abstract

A 50-year-old man presented with altered mental status during hospitalization for pneumonia. MRI showed multifocal ring-enhanced lesions, which consisted of multiple cerebral abscesses. We started empirical antibiotic therapy, but the following morning, his condition rapidly deteriorated and a CT scan revealed acute hydrocephalus, which required ventricular drainage. Gram staining of cerebro-spinal fluid from the ventricular drainage showed gram-positive cocci in chains, but culture results were negative. 16S ribosomal RNA sequencing with broad-range PCR of the cerebro-spinal fluid identified Streptococcus intermedius. On the basis of this identification, the antibiotic regimen was changed to ampicillin monotherapy. After 1 year of antibiotic therapy, all the abscesses had disappeared and the patient was discharged without any sequelae. Bacterial 16S rRNA gene analysis with broad-range PCR is a very useful method for facilitating the etiological diagnosis and selection of appropriate treatment for culture-negative infections.

• Authors: Nobuyuki Ohara, Katsunori Asai, Kiyofumi Ohkusu, Akatsuki Wakayama
• Journal: Brain and nerve = Shinkei kenkyu no shinpo (Brain Nerve) Vol. 65 Issue 10 Pg. 1199-203 (Oct 2013) ISSN: 1881-6096 [Print] Japan
• PMID: 24101431 (Publication Type: Case Reports, English Abstract, Journal Article)

Chemical References

• Anti-Bacterial Agents
• RNA, Ribosomal, 16S

Topics

• Anti-Bacterial Agents (therapeutic use)
• Brain Abscess (drug therapy, microbiology)
• Humans
• Male
• Middle Aged
• Polymerase Chain Reaction (methods)
• RNA, Ribosomal, 16S (genetics)
• Streptococcal Infections (complications, diagnosis, drug therapy, microbiology)
• Streptococcus intermedius (isolation & purification)