Paraclostridium tenue Causing an Anaerobic Brain Abscess Identified by Whole-Metagenome Sequencing: A Case Report.
Tetsuya ChibaYorito HattoriDaisuke MotookaTomotaka TanakaMasafumi IharaPublished in: Microorganisms (2024)
When treating anaerobic brain abscesses, healthcare professionals often face the difficulty of identifying the causal pathogens, necessitating empiric therapies with uncertain efficacy. We present the case of a 57-year-old woman who was admitted to our hospital with a fever and headache. Brain magnetic resonance imaging revealed a hemorrhagic lesion with wall enhancement at the left hemisphere on contrast-enhanced T1-weighted imaging. Cerebrospinal fluid examination showed pleocytosis (23 cells/μL), an elevated protein level (125 mg/dL), and decreased glucose level (51 mg/dL; blood glucose was 128 mg/dL). Intracerebral hemorrhage accompanied by a brain abscess was clinically suspected. The patient received empirical treatment with intravenous meropenem and vancomycin for 2 weeks. However, conventional bacterial culture tests failed to identify the pathogen. We then performed shotgun sequencing and ribosomal multilocus sequence typing, which identified Paraclostridium tenue . Based on this finding, we de-escalated to benzylpenicillin potassium for 4 weeks, leading to a 2.5-year remission of the anaerobic brain abscess. Therefore, Paraclostridium can be a causative pathogen for brain abscesses. Furthermore, whole-metagenome sequencing is a promising method for detecting rare pathogens that are not identifiable by conventional bacterial culture tests. This approach enables more targeted treatment and contributes to achieving long-term remission in clinical settings.
Keyphrases
- magnetic resonance imaging
- contrast enhanced
- resting state
- white matter
- blood glucose
- microbial community
- functional connectivity
- computed tomography
- magnetic resonance
- wastewater treatment
- cerebral ischemia
- single cell
- cerebrospinal fluid
- high resolution
- brain injury
- gram negative
- blood pressure
- induced apoptosis
- case report
- emergency department
- systemic lupus erythematosus
- rheumatoid arthritis
- oxidative stress
- skeletal muscle
- risk assessment
- staphylococcus aureus
- heavy metals
- cancer therapy
- photodynamic therapy
- weight loss
- signaling pathway
- combination therapy
- high dose
- endoplasmic reticulum stress
- preterm birth
- fluorescence imaging
- urinary tract infection