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Vâţă A, Irimie-Băluţă E, Roşu FM, Onofrei IM, Loghin II, Perţea M, Avădanei AN, Miron M, Rădulescu L, Eşanu I, Luca CM. Polymicrobial Bacterial Meningitis in a Patient with Chronic Suppurative Otitis Media: Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1428. [PMID: 37629718 PMCID: PMC10456347 DOI: 10.3390/medicina59081428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023]
Abstract
Polymicrobial meningitis is a rare entity in the adult population, especially in the antibiotic era. However, disorders such as chronic suppurative otitis media (CSOM) or even poor oral hygiene are considered risk factors for the development of such cerebral infection. We report a case of polymicrobial meningitis associated with oto-mastoiditis in a 64-year-old female patient known to have CSOM. The patient presented atypical symptoms for community-acquired meningitis, showing subacute evolution of headache, without fever or neck stiffness. The aerobe microorganisms Streptococcus anginosus and Corynebacterium spp., sensitive to beta-lactamines, and the anaerobe Prevotella spp., resistant to penicillin and metronidazole, were isolated from CSF specimens, while Proteus mirabilis and Enterococcus faecalis were identified from the ear drainage. The diversity of pathogens identified in our case led us to the hypothesis of two different sources of meningitis: otogenic and/or odontogenic. Favorable evolution was obtained after a multi-disciplinary approach, combining surgery and broad-spectrum antibiotics. In addition, we performed a literature review that highlights the low incidence of polymicrobial mixed aerobe-anaerobe meningitis.
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Affiliation(s)
- Andrei Vâţă
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.V.); (E.I.-B.); (I.M.O.); (C.M.L.)
- Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Erika Irimie-Băluţă
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.V.); (E.I.-B.); (I.M.O.); (C.M.L.)
| | - Florin Manuel Roşu
- Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
- Department of Dento-Alveolar Surgery, Anesthesia, Sedation, and Medical-Surgical Emergencies, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ioana Maria Onofrei
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.V.); (E.I.-B.); (I.M.O.); (C.M.L.)
- Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Isabela Ioana Loghin
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.V.); (E.I.-B.); (I.M.O.); (C.M.L.)
- Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Mihaela Perţea
- Department of Surgery 1, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania;
| | | | - Mihnea Miron
- Intensive Care Department, “Sf. Spiridon” Emergency Hospital, 700115 Iasi, Romania;
| | - Luminiţa Rădulescu
- ENT Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Irina Eşanu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania;
| | - Cătălina Mihaela Luca
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.V.); (E.I.-B.); (I.M.O.); (C.M.L.)
- Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
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Haue AD, Ilsby C, Calum HP, Helweg-Larsen J. Filifactor alocis and Porphyromonas gingivalis bacteraemia associated with purulent meningitis and cholesteatoma: A case report. CLINICAL INFECTION IN PRACTICE 2022. [DOI: 10.1016/j.clinpr.2022.100206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Cheng H, Xu L, Yang F, Jia L, Zhao D, Li H, Liu W, Li Y, Liu X, Geng X, Guo J, Ling C, Zhang J. Case report: Meningitis and intracranial aneurysm caused by mixed infection of oral microflora dominated by anaerobes. Front Neurol 2022; 13:889838. [PMID: 35989934 PMCID: PMC9389152 DOI: 10.3389/fneur.2022.889838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Meningitis caused by oral anaerobic bacteria is rare, especially when complicated with an infected intracranial aneurysm. This paper has described an extremely rare case of bacterial meningitis caused by a mixed infection of oral microflora dominated by anaerobes, which developed cerebral infarcts, brain abscess, intracranial aneurysm, and severe hydrocephalus during treatment. Case report We describe a 65-year-old male patient who was presented with fever and headache as the initial symptoms and then developed left ophthalmoplegia, right hemiplegia, and disturbance of consciousness. Brain imaging showed that intracranial lesions were increased progressively, and cerebral infarcts, brain abscesses, intracranial aneurysm, and severe hydrocephalus were appeared gradually. Eventually, we diagnosed it as anaerobic meningitis by making deoxyribonucleic acid sequencing from the brain abscess pus. After using an anti-microbial regimen that can sufficiently cover anaerobes, the patient's condition was effectively controlled. Conclusion Anaerobic meningitis can cause a series of intracranial complications. Among them, the intracranial aneurysm is extremely rare. When evidence shows that the infection originates from oral flora, physicians should consider the possibility of this type of encephalitis. An early diagnosis and timely treatment are crucial to improving the prognosis.
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Affiliation(s)
- Hongjiang Cheng
- Department of Neurology, Jincheng People's Hospital Affiliated to Shanxi Medical University, Jincheng, China
| | - Lina Xu
- Department of Neurology, Jincheng People's Hospital Affiliated to Shanxi Medical University, Jincheng, China
- *Correspondence: Lina Xu
| | - Fengbing Yang
- Department of Neurology, Jincheng People's Hospital Affiliated to Shanxi Medical University, Jincheng, China
| | - Longbin Jia
- Department of Neurology, Jincheng People's Hospital Affiliated to Shanxi Medical University, Jincheng, China
- Longbin Jia
| | - Doudou Zhao
- Department of Rheumatology, Jincheng People's Hospital Affiliated to Shanxi Medical University, Jincheng, China
- Doudou Zhao
| | - Huimin Li
- Department of Neurology, Jincheng People's Hospital Affiliated to Shanxi Medical University, Jincheng, China
| | - Wei Liu
- Department of Neurology, Jincheng People's Hospital Affiliated to Shanxi Medical University, Jincheng, China
| | - Yujuan Li
- Department of Neurology, Jincheng People's Hospital Affiliated to Shanxi Medical University, Jincheng, China
| | - Xiaoli Liu
- Department of Neurology, Jincheng People's Hospital Affiliated to Shanxi Medical University, Jincheng, China
| | - Xia Geng
- Department of Neurology, Jincheng People's Hospital Affiliated to Shanxi Medical University, Jincheng, China
| | - Jiaying Guo
- Department of Neurology, Jincheng People's Hospital Affiliated to Shanxi Medical University, Jincheng, China
| | - Chen Ling
- Graduate School of Changzhi Medical College, Changzhi, China
| | - Jing Zhang
- Graduate School of Changzhi Medical College, Changzhi, China
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Karvouniaris M, Brotis A, Tsiakos K, Palli E, Koulenti D. Current Perspectives on the Diagnosis and Management of Healthcare-Associated Ventriculitis and Meningitis. Infect Drug Resist 2022; 15:697-721. [PMID: 35250284 PMCID: PMC8896765 DOI: 10.2147/idr.s326456] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/05/2022] [Indexed: 12/31/2022] Open
Abstract
Ventriculitis or post-neurosurgical meningitis or healthcare-associated ventriculitis and meningitis (VM) is a severe infection that complicates central nervous system operations or is related to the use of neurosurgical devices or drainage catheters. It can further deteriorate patients who have already presented significant neurologic injury and is associated with high morbidity, mortality, and poor functional outcome. VM can be difficult to distinguish from aseptic meningitis, inflammation that follows hemorrhagic strokes and neurosurgical operations. The associated microorganisms can be either skin flora or nosocomial pathogens, most commonly, Gram-negative bacteria. Classical microbiology can fail to isolate the culprit pathogen. Novel cerebrospinal fluid (CSF) biomarkers and molecular microbiology can fill the diagnostic gap and expedite pathogen identification and treatment. The pathogens may demonstrate significant resistant patterns and their antibiotic treatment can be difficult, as many important drug classes, including the beta-lactams and the glycopeptides, hardly penetrate to the CSF, and do not achieve therapeutic levels at the site of the infection. Treatment modifications, such as higher daily dose and prolonged or continuous administration, might increase antibiotic levels in the site of infection and facilitate pathogens clearance. However, in the case of therapeutic failure or infection due to difficult-to-treat bacteria, the direct antibiotic instillation into the CSF, in addition to the intravenous antibiotic delivery, may help in the resolution of infection. However, intraventricular antibiotic therapy may result in aseptic meningitis and seizures, concerning the administration of aminoglycosides, polymyxins, and vancomycin. Meanwhile, bacteria form biofilms on the catheter or the device that should routinely be removed. Novel neurosurgical treatment modalities comprise endoscopic evacuation of debris and irrigation of the ventricles. VM prevention includes perioperative antibiotics, antimicrobial impregnated catheters, and the implementation of standardized protocols, regarding catheter insertion and manipulation.
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Affiliation(s)
- Marios Karvouniaris
- Intensive Care Unit, AHEPA University Hospital, Thessaloniki, Greece
- Correspondence: Marios Karvouniaris, ACHEPA University Hospital, S.Kiriakidi 1, Thessaloniki, 54636, Greece, Tel +302313303645, Fax +302313303096, Email
| | - Alexandros Brotis
- Neurosurgery Department, University Hospital of Larissa, Larissa, Greece
| | | | - Eleni Palli
- Intensive Care Unit, University Hospital of Larissa, Larissa, Greece
| | - Despoina Koulenti
- Second Critical Care Department, Attikon University Hospital, Athens, Greece
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Luo L, Wang C, Shen N, Zhao R, Tao Y, Mo X, Cao Q. Polymicrobial anaerobic bacterial meningitis secondary to dermal sinus: a case report. Transl Pediatr 2021; 10:3118-3123. [PMID: 34976779 PMCID: PMC8649605 DOI: 10.21037/tp-21-210] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/12/2021] [Indexed: 01/19/2023] Open
Abstract
Anaerobic bacterial meningitis is a rare infectious disease, and there are some special predisposing factors for it. We report a case of polymicrobial anaerobic bacterial meningitis in a nine-month-old boy who visited our hospital due to "fever with drowsiness and vomiting for 2 days". It was confirmed by the method of sanger sequencing after polymerase chain reaction (PCR) that the purulent meningitis was caused by a mixture of four anaerobic bacteria (Finegoldia magna, Campylobacter ureolyticus, Bacteroides fragilis and Porphyromonas bennonis). Even though there was no obvious structural abnormality on the skin surface, magnetic resonance imaging (MRI) examination suggested the presence of a sacrococcygeal dermal sinus. It was proven that anaerobic bacterial meningitis was secondary to retrograde infection of the dermal sinus. Finally, he was cured by a combination of anti-infection measures and surgical treatment. In conclusion, using appropriate molecular diagnostic techniques may quickly and accurately determine the pathogenic bacteria of anaerobic bacterial meningitis. When anaerobic bacterial meningitis occurs, the presence of structural abnormalities such as dermal sinus needs to be ruled out to avoid recurrence of the disease. In addition to anti-infective treatment, patients with dermal sinuses should undergo surgery as soon as possible to address abnormal structures and their root causes.
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Affiliation(s)
- Lijuan Luo
- Department of Infectious Diseases, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Cuijin Wang
- Department of Neurology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Nan Shen
- Department of Infectious Diseases, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ruike Zhao
- The Laboratory of Pediatric Infectious Diseases, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yue Tao
- The Laboratory of Pediatric Infectious Diseases, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xi Mo
- The Laboratory of Pediatric Infectious Diseases, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Cao
- Department of Infectious Diseases, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Hodor P, Pope CE, Whitlock KB, Hoffman LR, Limbrick DL, McDonald PJ, Hauptman JS, Ojemann JG, Simon TD. Molecular Characterization of Microbiota in Cerebrospinal Fluid From Patients With CSF Shunt Infections Using Whole Genome Amplification Followed by Shotgun Sequencing. Front Cell Infect Microbiol 2021; 11:699506. [PMID: 34490140 PMCID: PMC8417900 DOI: 10.3389/fcimb.2021.699506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/29/2021] [Indexed: 11/13/2022] Open
Abstract
Understanding the etiology of cerebrospinal fluid (CSF) shunt infections and reinfections requires detailed characterization of associated microorganisms. Traditionally, identification of bacteria present in the CSF has relied on culture methods, but recent studies have used high throughput sequencing of 16S rRNA genes. Here we evaluated the method of shotgun DNA sequencing for its potential to provide additional genomic information. CSF samples were collected from 3 patients near the beginning and end of each of 2 infection episodes. Extracted total DNA was sequenced by: (1) whole genome amplification followed by shotgun sequencing (WGA) and (2) high-throughput sequencing of the 16S rRNA V4 region (16S). Taxonomic assignments of sequences from WGA and 16S were compared with one another and with conventional microbiological cultures. While classification of bacteria was consistent among the 3 approaches, WGA provided additional insights into sample microbiological composition, such as showing relative abundances of microbial versus human DNA, identifying samples of questionable quality, and detecting significant viral load in some samples. One sample yielded sufficient non-human reads to allow assembly of a high-quality Staphylococcus epidermidis genome, denoted CLIMB1, which we characterized in terms of its MLST profile, gene complement (including putative antimicrobial resistance genes), and similarity to other annotated S. epidermidis genomes. Our results demonstrate that WGA directly applied to CSF is a valuable tool for the identification and genomic characterization of dominant microorganisms in CSF shunt infections, which can facilitate molecular approaches for the development of better diagnostic and treatment methods.
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Affiliation(s)
- Paul Hodor
- Seattle Children's Hospital, Seattle, WA, United States
| | - Christopher E Pope
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | | | - Lucas R Hoffman
- Seattle Children's Hospital, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - David L Limbrick
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO, United States
| | - Patrick J McDonald
- Division of Neurosurgery, University of British Columbia, Vancouver, BC, Canada
| | - Jason S Hauptman
- Seattle Children's Hospital, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Jeffrey G Ojemann
- Seattle Children's Hospital, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Tamara D Simon
- Children's Hospital Los Angeles, Los Angeles, CA, United States.,Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, CA, United States
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7
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Bertolini M, Vazquez Munoz R, Archambault L, Shah S, Souza JGS, Costa RC, Thompson A, Zhou Y, Sobue T, Dongari-Bagtzoglou A. Mucosal Bacteria Modulate Candida albicans Virulence in Oropharyngeal Candidiasis. mBio 2021; 12:e0193721. [PMID: 34399623 PMCID: PMC8406182 DOI: 10.1128/mbio.01937-21] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 01/12/2023] Open
Abstract
Oropharyngeal candidiasis (OPC) is the most prevalent oral infection in immunocompromised patients, primarily associated with Candida albicans. Increasing evidence points to a significant role of mucosal bacteria on the transition of C. albicans from commensal to pathogenic. In this work, we hypothesized that changes in the abundance or composition of the mucosal bacterial microbiota induced by dietary sucrose during the development of OPC can modulate C. albicans virulence. C. albicans burdens and mucosal lesions were evaluated in a mouse cortisone immunosuppression model amended with sucrose. We also analyzed the mucosal bacterial composition using 16S rRNA gene sequencing and culture methods. In immunocompetent mice, sucrose significantly increased total bacterial burdens and reduced alpha diversity, by increasing the relative abundance of mitis group streptococci. In immunocompromised mice, C. albicans infection was associated with a significantly reduced bacterial alpha diversity due to an increase in the relative abundance of enterococci. When exposed to dietary sucrose, these mice had reduced C. albicans burdens and reduced bacterial alpha diversity, associated with an increase in the relative abundance of Lactobacillus. SparCC correlation networks showed a significant negative correlation between Lactobacillus and Enterococcus in all Candida-infected mice. Depletion of lactobacilli with antibiotic treatment partially restored C. albicans burdens in mice receiving sucrose. In coculture in vitro experiments, mouse oral Lactobacillus johnsonii isolates inhibited growth of Enterococcus faecalis isolates and C. albicans. These results support the hypothesis that the sucrose-induced attenuation of C. albicans virulence was a result of changes in the mucosal bacterial microbiome characterized by a reduction in enterococci and an increase in lactobacilli. IMPORTANCE By comparing Candida albicans virulence and the mucosal bacterial composition in a mouse oral infection model, we were able to dissect the effects of the host environment (immunosuppression), infection with C. albicans, and local modulating factors (availability of sucrose as a carbon source) on the mucosal bacterial microbiome and its role on fungal virulence. We showed that changes in endogenous microbial communities in response to sucrose can lead to attenuation of fungal disease. We also showed that Lactobacillus johnsonii may curtail Candida virulence both by inhibiting its growth and by inhibiting the growth of potentially synergistic bacteria such as enterococci. Our results support the concept that Candida pathogenesis should be viewed in the contexts of both a susceptible host and a mucosal bacterial microbiota conducive to virulence.
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Affiliation(s)
- M. Bertolini
- Department of Oral Health and Diagnostic Sciences, UConn Health, Farmington, Connecticut, USA
| | - R. Vazquez Munoz
- Department of Oral Health and Diagnostic Sciences, UConn Health, Farmington, Connecticut, USA
| | - L. Archambault
- Department of Oral Health and Diagnostic Sciences, UConn Health, Farmington, Connecticut, USA
| | - S. Shah
- Department of Computer Science and Engineering, University of Connecticut, Storrs, Connecticut, USA
| | - J. G. S. Souza
- Dental Research Division, Guarulhos University, Guarulhos, SP, Brazil
- Dental Science School (Faculdade de Ciências Odontológicas [FCO]), Montes Claros, MG, Brazil
| | - R. C. Costa
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - A. Thompson
- Department of Oral Health and Diagnostic Sciences, UConn Health, Farmington, Connecticut, USA
| | - Y. Zhou
- Department of Medicine, UConn Health, Connecticut, Farmington, Connecticut, USA
| | - T. Sobue
- Department of Oral Health and Diagnostic Sciences, UConn Health, Farmington, Connecticut, USA
| | - A. Dongari-Bagtzoglou
- Department of Oral Health and Diagnostic Sciences, UConn Health, Farmington, Connecticut, USA
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Chatzopoulos K, Shannon S, Schuetz AN. Clinical utility of anaerobic culture of cerebrospinal fluid. Anaerobe 2020; 64:102246. [PMID: 32717475 DOI: 10.1016/j.anaerobe.2020.102246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 01/20/2023]
Abstract
Anaerobic meningitis is a rare serious clinical condition which mainly affects vulnerable populations and patients with predisposing factors such as head trauma, prior neurosurgical procedures or implantable medical devices such as ventriculoperitoneal shunts or ventricular drains. In this study we retrieved data from aerobic and anaerobic cultures of cerebrospinal (CSF) or ventricular fluid ordered over a 5 year period at our institution. A total of 8868 aerobic and 594 anaerobic cultures were performed from 2013 to 2017. 24/594 (4%) anaerobic cultures from 14 patients were positive for anaerobes. Only 3 of those patients were diagnosed clinically with anaerobic meningitis, each with predisposing factors, while anaerobes (Cutibacterium acnes and Clostridium perfringens) recovered from the remaining 21 patients were regarded as contaminants. 129/8868 (1.45%) aerobic CSF cultures were positive for anaerobes. 120/129 (93%) cultures recovered C. acnes while non-C. acnes anaerobes were recovered in the remaining 9 cultures and were deemed to be contaminants. In the majority of situations, recovery of C. acnes from CSF or ventricular fluid was regarded as contamination. Our cohort included 18 patients with a ventriculoperitoneal shunt or ventricular drain, 17 of whom had C. acnes recovered from either aerobic or anaerobic culture, and 10 were treated with targeted antibiotics and surgical replacement of the shunt or drain. Anaerobic culture of the CSF or ventricular fluid aided in identification of two patients with anaerobic meningitis and an additional two patients with shunt infection. Anaerobe culture of CSF is important in identification of anaerobic meningitis, as growth of anaerobes other than C. acnes is rare from aerobic CSF culture.
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Affiliation(s)
- Kyriakos Chatzopoulos
- Department of Laboratory Medicine and Pathology Division of Clinical Microbiology Mayo Clinic, Rochester, MN, USA
| | - Samantha Shannon
- Department of Laboratory Medicine and Pathology Division of Clinical Microbiology Mayo Clinic, Rochester, MN, USA
| | - Audrey N Schuetz
- Department of Laboratory Medicine and Pathology Division of Clinical Microbiology Mayo Clinic, Rochester, MN, USA.
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Abstract
PURPOSE OF REVIEW While acute bacterial meningitis is becoming less common in developed countries because of the widespread use of vaccines against Streptococcus pneumoniae, Neisseria meningitides, and Haemophilus influenzae, bacterial meningitis still occurs worldwide, with peak incidence in young children and the elderly. Bacterial meningitis is usually lethal unless appropriate antibiotics that cross the blood-brain barrier are given. Clinical suspicion of bacterial meningitis begins when patients present with the abrupt onset of fever, headache, and meningismus. RECENT FINDINGS New technologies are being developed for more rapid identification of the bacterial species causing meningitis. When appropriate, administration of adjunctive dexamethasone with the antibiotics often lessens neurologic sequelae in survivors, which may include aphasia, ataxia, paresis, hearing loss, and cognitive impairment. SUMMARY Confirmation of the diagnosis of bacterial meningitis comes mainly from examination and culture of CSF obtained from a lumbar puncture. Typically, the CSF shows an elevated neutrophil count, elevated protein, depressed glucose, positive Gram stain, and growth of the bacteria on appropriate culture media. Antibiotic sensitivities of the bacteria determine the appropriate antibiotics, although an educated guess of the best antibiotics to be given promptly must be made until the antibiotic sensitivities return, usually in a few days.
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Bertolini M, Ranjan A, Thompson A, Diaz PI, Sobue T, Maas K, Dongari-Bagtzoglou A. Candida albicans induces mucosal bacterial dysbiosis that promotes invasive infection. PLoS Pathog 2019; 15:e1007717. [PMID: 31009520 PMCID: PMC6497318 DOI: 10.1371/journal.ppat.1007717] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/02/2019] [Accepted: 03/19/2019] [Indexed: 12/12/2022] Open
Abstract
Infectious complications are a common cause of morbidity and mortality in cancer patients undergoing chemotherapy due to increased risk of oral and gastrointestinal candidiasis, candidemia and septicemia. Interactions between C. albicans and endogenous mucosal bacteria are important in understanding the mechanisms of invasive infection. We published a mouse intravenous chemotherapy model that recapitulates oral and intestinal mucositis, and myelosuppression in patients receiving 5-fluorouracil. We used this model to study the influence of C. albicans on the mucosal bacterial microbiome and compared global community changes in the oral and intestinal mucosa of the same mice. We validated 16S rRNA gene sequencing data by qPCR, in situ hybridization and culture approaches. Mice receiving both 5Fu and C. albicans had an endogenous bacterial overgrowth on the oral but not the small intestinal mucosa. C. albicans infection was associated with loss of mucosal bacterial diversity in both sites with indigenous Stenotrophomonas, Alphaproteobacteria and Enterococcus species dominating the small intestinal, and Enterococcus species dominating the oral mucosa. Both immunosuppression and Candida infection contributed to changes in the oral microbiota. Enterococci isolated from mice with oropharyngeal candidiasis were implicated in degrading the epithelial junction protein E-cadherin and increasing the permeability of the oral epithelial barrier in vitro. Importantly, depletion of these organisms with antibiotics in vivo attenuated oral mucosal E-cadherin degradation and C. albicans invasion without affecting fungal burdens, indicating that bacterial community changes represent overt dysbiosis. Our studies demonstrate a complex interaction between C. albicans, the resident mucosal bacterial microbiota and the host environment in pathogenesis. We shed significant new light on the role of C. albicans in shaping resident bacterial communities and driving mucosal dysbiosis.
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Affiliation(s)
- Martinna Bertolini
- Department of Oral Health Sciences, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Amit Ranjan
- Department of Oral Health Sciences, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Angela Thompson
- Department of Oral Health Sciences, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Patricia I. Diaz
- Department of Oral Health Sciences, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Takanori Sobue
- Department of Oral Health Sciences, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Kendra Maas
- Microbial Analysis, Resources, and Services Core, University of Connecticut, Storrs, Connecticut, United States of America
| | - Anna Dongari-Bagtzoglou
- Department of Oral Health Sciences, University of Connecticut Health Center, Farmington, Connecticut, United States of America
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Diagnostic Approach to Health Care- and Device-Associated Central Nervous System Infections. J Clin Microbiol 2018; 56:JCM.00861-18. [PMID: 30135235 DOI: 10.1128/jcm.00861-18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Health care- and device-associated central nervous system (CNS) infections have a distinct epidemiology, pathophysiology, and microbiology that require a unique diagnostic approach. Most clinical signs, symptoms, and tests used to diagnose community-acquired CNS infections are insensitive and nonspecific in neurosurgical patients due to postsurgical changes, invasive devices, prior antimicrobial exposure, and underlying CNS disease. The lack of a standardized definition of infection or diagnostic pathway has added to this challenge. In this review, we summarize the epidemiology, microbiology, and clinical presentation of these infections, discuss the issues with existing microbiologic tests, and give an overview of the current diagnostic approach.
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12
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Anaerobic bacterial meningitis in adults. J Clin Neurosci 2018; 50:45-50. [DOI: 10.1016/j.jocn.2018.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/05/2018] [Indexed: 11/19/2022]
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Utility of strain typing of Propionibacterium acnes in central nervous system and prosthetic joint infections to differentiate contamination from infection: a retrospective cohort. Eur J Clin Microbiol Infect Dis 2017; 36:2483-2489. [PMID: 28842758 DOI: 10.1007/s10096-017-3090-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/09/2017] [Indexed: 02/07/2023]
Abstract
The study aimed to retrospectively assess if strain typing of Propionibacterium acnes could help to distinguish between infection and contamination in isolates recovered from the central nervous system (CNS) and prosthetic joints (PJs). This was a retrospective cohort of all Propionibacterium species isolates from the Barnes-Jewish Hospital (St Louis, MO, USA) clinical microbiology laboratory from 2011 to 2014. Available frozen isolates were recovered, and strain type (IA-1, IA-2, IB, II, III, or nontypeable class A or B) was determined via polymerase chain reaction (PCR)-based methods. For CNS isolates, P. acnes was considered pathogenic if treating physicians administered ≥7 days of directed antibiotic therapy against P. acnes. During the study period, Propionibacterium species was isolated from clinical cultures 411 times. 152 isolates were available for analysis. Of the 152 isolates, 140 were confirmed to be P. acnes, 61 of which were from the CNS (45 contaminants, 16 infections). Strain type IA-1 was more common (50.0%, 8 out of 16) among CNS infections than among contaminants (22.2%, 10 out of 45). For PJ isolates 61.3% (19 out of 31) met the criteria for infection. The predominant strain type for CNS infection was IA-1 and for PJ isolates, IB. Strain type IA-1 was isolated more often in patients with CNS infections, which may indicate a predilection of this strain type to cause CNS infection. Future research should prospectively evaluate strain typing as a means of assisting in the diagnosis of CNS infections and confirm our findings.
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Lien CY, Huang CR, Tsai WC, Hsu CW, Tsai NW, Chang CC, Lu CH, Chien CC, Chang WN. Epidemiologic trend of adult bacterial meningitis in southern Taiwan (2006–2015). J Clin Neurosci 2017; 42:59-65. [DOI: 10.1016/j.jocn.2017.03.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/06/2017] [Indexed: 12/28/2022]
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Wylie K, Blanco-Guzman M, Wylie T, Lawrence S, Ghobadi A, DiPersio J, Storch G. High-throughput sequencing of cerebrospinal fluid for diagnosis of chronicPropionibacterium acnesmeningitis in an allogeneic stem cell transplant recipient. Transpl Infect Dis 2016; 18:227-33. [DOI: 10.1111/tid.12512] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/18/2015] [Accepted: 12/11/2015] [Indexed: 11/30/2022]
Affiliation(s)
- K.M. Wylie
- Department of Pediatrics; Washington University School of Medicine; St. Louis Missouri USA
- The McDonnell Genome Institute; Washington University School of Medicine; St. Louis Missouri USA
| | - M. Blanco-Guzman
- Department of Medicine; Washington University School of Medicine; St. Louis Missouri USA
| | - T.N. Wylie
- Department of Pediatrics; Washington University School of Medicine; St. Louis Missouri USA
- The McDonnell Genome Institute; Washington University School of Medicine; St. Louis Missouri USA
| | - S.J. Lawrence
- Department of Medicine; Washington University School of Medicine; St. Louis Missouri USA
| | - A. Ghobadi
- Department of Medicine; Washington University School of Medicine; St. Louis Missouri USA
| | - J.F. DiPersio
- Department of Medicine; Washington University School of Medicine; St. Louis Missouri USA
| | - G.A. Storch
- Department of Pediatrics; Washington University School of Medicine; St. Louis Missouri USA
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Khalil A, Mandiwanza T, Zakaria Z, Crimmins D. Routine cerebrospinal fluid analysis during ‘de novo’ ventriculoperitoneal shunt insertion: Single Institution Experience. Br J Neurosurg 2016; 30:427-8. [DOI: 10.3109/02688697.2015.1119235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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New DW, Pryce TM. Meningitis caused by Porphyromonas endodontalis detected by PCR amplification and sequencing of 16S rRNA genes direct from cerebrospinal fluid and cerebral tissue. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- David W. New
- Department of Microbiology, PathWest Laboratory Medicine, Fremantle Hospital, Western Australia, Australia
| | - Todd M. Pryce
- Department of Microbiology and Infectious Diseases, Fiona Stanley Hospital Network, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
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