A pyo-hydropneumothorax with sepsis, secondary to Gardnerella vaginalis infection in a post-partum female

Abstract

A 20 year old female, 14 days post partum, presented to the Emergency Department in severe respiratory distress. Imaging of her chest revealed a left tension hydropneumothorax with significant mediastinal displacement. A chest drain was inserted and over 4L of cloudy-brown malodourous fluid was drained. Gardnerella Vaginalis was isolated on culture of the fluid. The pyohydropneumothorax and associated sepsis, was refractory to management with a chest drain and antimicrobial therapy. She required a video-assisted thoracoscopic surgery and decortication of her unexpanded lung. She ultimately made a full recovery. Gardnerella vaginalis is considered a dysbiosis of the genitourinary tract, rather than an overtly virulent pathogen. Although extremely rare, there are occasional reports of Gardnerella vaginalis causing infection, even at sites distant from the genitourinary tract. To our knowledge, this is the first documented case of Gardnerella vaginalis causing respiratory sepsis and a pyohydropneumothorax in a healthy, immunocompetent female during the post-partum period. Although it is a unique case, nevertheless, it highlights the need for physicians to be congnisant of G. vaginalis as a potential pathogen when treating post-partum sepsis and indeed, even as a potential pathogen when treating pulmonary infections in obstetric patients. This will lend to prompt initiation of appropriate antimicrobial treatment.

Gardnerella and vaginal health: the truth is out there

“…Gardnerella spp. is also reported as the pathogen involved in some infrequent infections such as wound infection (Sturm, de Leeuw and de Pree 1983), tubo-ovarian abscess (Burgess, Daramola and Lacey 1997), meningitis (Berardi-Grassias et al 1988), retinal vasculitis (Neri et al 2009), cephalohematoma (Nightingale et al 1986), and hydropneumothorax (Murray et al 2019).…”

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

“…2 Extravaginal infections by G. vaginalis such as bacteremia, joint infections, and spinal dural abscess, rarely occur, 5–7 while lung infections and pleural effusions in female patients have also been documented. 8 Similarly, studies have found that the vaginal Gardnerella biofilm is sexually transmitted, with some heterosexual couples found to share the same G. vaginalis strain, 9 indicating that it can also be found in the male genitalia. However, reports about infection of other parts of men are relatively rare.…”

“… Calvert et al 18 2005 Male 50 Multiple abscesses Smoked 20 cigarettes a day for 30 years and drank 25 units of alcohol a week. Right perinephric and pleural aspirates culture IV high dose benzylpenicillin, cefuroxime and metronidazole for 41 days→oral metronidazole 400 mg twice daily and amoxycillin 500 mg three times a day Bittar et al 25 2019 Male 20 Pulmonary infection Previously healthy Respiratory secretions for culture by mini bronchoalveolar lavage Intravenous Vancomycin and Piperacillin/Tazobactam for 11 days→ampicillin-sul bactam for 4 days→Vancomycin and Cefepime metronidazole treatment for 4 days→ceftriaxone and metronidazole MurrayL 8 2019 Female 20 Pyohydropneumothorax and associated respiratory sepsis 14 days post partum Isolation from pleural fluid Piperacillin-Tazobactam 4.5g TDS and Vancomycin 15mg/Kg (1g) BD→clindamycin 800mg IV TDS→ a video-assisted thoracoscopic surgery Tamlihat 29 2020 Male 45 VAP Cardiorespiratory arrest; post-anoxic encephalopathy; inhalation pneumonia. Protected distal bronchial sampling Amoxicillin-clavulanic acid; cefotaxime + metronidazole …”

A case report of septic gardnerellosis

“…Additional reports describe the septic form of gardnerellosis occurring in infants [ 18 ], and in female and male immunocompromised patients [ 24 , 25 ]. Moreover, urinary abnormalities and alcoholism have shown to be contributing factors to G. vaginalis bacteremia in males and occasional cases of sepsis have been described [ 9 , 24 , [26] , [27] , [28] , [29] , [30] ].…”