A Rare Cause of a Scrotal Abscess due to the Symbiotic Infection of Gardnerella vaginalis and Prevotella bivia in an Adult Male

Prosthetic Joint Infection Caused by Gardnerella vaginalis: Case Report and Review of the Literature

Prosthetic joint infection is not uncommon, but Gardnerella vaginalis has been reported rarely as a causative agent. A 45-year-old patient with no remarkable history was admitted to the hospital ten months after total hip replacement because of loosening of the prosthesis. Initial culture grew S. anginosus. Repeated culture of the debridement material grew G. vaginalis. After adequate and effective treatment, he was discharged in good health. This is the first case of a male patient with prosthetic joint infection caused by G. vaginalis. This pathogen should be considered in the presence of slow-growing, gram-variable rods in culture.

Metagenomic Next-Generation Sequencing Assists in the Diagnosis of Gardnerella vaginalis in Males with Pleural Effusion and Lung Infection: A Case Report and Literature Review

Gardnerella vaginalis is a pathogen responsible for bacterial vaginosis, which is commonly found in female vaginas and rarely causes infections outside the female genitalia. Here, we report the use of metagenomic next-generation sequencing (mNGS) to detect and confirm pulmonary infection and pleural effusion caused by G. vaginalis in a 47-year-old man. The patient's symptoms and imaging improved after 2 weeks of oral ornidazole, and he was cured after 3 months. Overall, the findings of this case demonstrate that mNGS is a useful tool for diagnosis of unexplained lung infections and pleural effusions. Its effectiveness in rapid and accurate etiological diagnosis and monitoring of diseases can allow detection of the etiology of difficult cases that return negative results after traditional cultures.

Gardnerella vaginalis Is a Rare Cause of Ventilator-Associated Pneumonia: A Case Report and Literature Review

Gardnerella vaginalis (G. vaginalis) is a commensal bacterium of the vaginal flora, facultative anerobic with Gram-variable, frequently implicated in cases of vaginosis or even infections of the genitourinary tract, rarely responsible for systemic infections and very exceptionally isolated in bronchopulmonary damage. We report here a case of G. vaginalis pneumonia in a 45-year-old man admitted to the intensive care unit for cardiorespiratory arrest (CRA) by hanging, whose course was unfavorable following severe post-anoxic encephalopathy. During his hospitalization, the patient presented ventilator-associated pneumonia (VAP) with identification of G. vaginalis at a significant threshold on the protected distal bronchial sampling (PDBS). Antibiotic therapy with cefotaxime and metronidazole had a good response to this infection. In this observation, we discuss the pathogenic role and identification of G. vaginalis at the pulmonary level.

Scrotal Abscess in a Japanese Patient Caused by Prevotella bivia and Streptococcus agalactiae, Successfully Treated with Cefazolin and Amoxicillin: A Case Report

Background

Infections caused by Prevotella bivia, a gram-negative anaerobic bacillus, are rare, with no reported cases in Japan. We present a novel case of scrotal abscess in a Japanese patient co-infected with Prevotella bivia and Streptococcus agalactiae.

Case Presentation

A 41-year-old uncontrolled diabetic man complained of swelling and pain in the scrotum. On examination, computed tomography revealed an abscess of 5-cm diameter in the scrotum. Then, the abscess was incised and drained. He was treated with cefazolin empirically. Prevotella bivia and Streptococcus agalactiae were identified in the pus cultures obtained from the abscess. However, the susceptibility tests for Prevotella bivia could not be submitted. Seven days following admission, the pain reduced, and the drainage slowed. The patient was discharged on day 14 when cefazolin was discontinued and oral amoxicillin (750 mg/day) was started. Amoxicillin was continued until day 42; improvement was confirmed.

Conclusion

To the best of our knowledge, this case is the first report of Prevotella bivia in Japan. We suggest that cephem antibiotics such as cefazolin may be effective against Prevotella bivia in Japan.

Highlights in poloxamer-based drug delivery systems as strategy at local application for vaginal infections

Infectious diseases related to the vagina include diseases caused by the imbalance of the vaginal flora and by sexually transmitted infections. Some of these present themselves as a public health problem due to the lack of efficient treatment that leads to their complete cure, and others due to the growing resistance to drugs used in therapy. In this sense, new treatment strategies are desirable, with vaginal administration rout being a great choice since can bypass first-pass metabolism and decrease drug interactions and adverse effects. However, it is worth highlighting limitations related to patient's discomfort at application time. Thereby, the use of poloxamer-based drug delivery systems is desirable due its stimuli-sensitive characteristic. Therefore, the present review reports a brief overview of poloxamer properties, biological behavior and advances in poloxamer applications in controlled drug release systems for infectious diseases related to the vagina treatment and prevention.

Atopobium vaginae and Prevotella bivia Are Able to Incorporate and Influence Gene Expression in a Pre-Formed Gardnerella vaginalis Biofilm

Bacterial vaginosis (BV) is associated with a highly structured polymicrobial biofilm on the vaginal epithelium where Gardnerella species presumably play a pivotal role. Gardnerella vaginalis, Atopobium vaginae, and Prevotella bivia are vaginal pathogens detected during the early stages of incident BV. Herein, we aimed to analyze the impact of A. vaginae and P. bivia on a pre-established G. vaginalis biofilm using a novel in vitro triple-species biofilm model. Total biofilm biomass was determined by the crystal violet method. We also discriminated the bacterial populations in the biofilm and in its planktonic fraction by using PNA FISH. We further analyzed the influence of A. vaginae and P. bivia on the expression of key virulence genes of G. vaginalis by quantitative PCR. In our tested conditions, A. vaginae and P. bivia were able to incorporate into pre-established G. vaginalis biofilms but did not induce an increase in total biofilm biomass, when compared with 48-h G. vaginalis biofilms. However, they were able to significantly influence the expression of HMPREF0424_0821, a gene suggested to be associated with biofilm maintenance in G. vaginalis. This study suggests that microbial relationships between co-infecting bacteria can deeply affect the G. vaginalis biofilm, a crucial marker of BV.

Rare case of Prevotella pleuritidis lung abscess

Prevotella genus comprises of obligate anaerobic, gram-negative bacteria that are commensal organisms of oral cavity, gut and vaginal mucosa. Although many Prevotella species have well-established pathogenicity with respect to pulmonary infections, rarely has Prevotella pleuritidis been isolated as a cause of lung abscess. We present a rare case of left lower lobe lung abscess due to P. pleuritidis identified using next-generation sequencing of microbial cell-free DNA testing. A brief review of the literature regarding Prevotella species pulmonary infections, use of next-generation cell-free DNA testing early in the evaluation, antibiotic susceptibility and resistance is also a part of this report.

Gardnerella vaginalis bacteremia in an elderly healthy male

Gardnerella vaginalis is an anaerobic gram variable organism, which commonly causes bacterial vaginosis in women. It is uncommon for this organism to cause a urinary tract infection in males. We present a case of G. vaginalis bacteremia in the setting of urolithiasis in an otherwise immunocompetent elderly male. He was treated with metronidazole alone for a 10-day course with resolution of symptoms and negative repeat blood cultures. It is important for health care professionals to acknowledge this rare cause of infection in males and adequately treat to prevent increased morbidity and mortality.