Case report:Multiple abscesses caused by Porphyromonas gingivalis diagnosed by metagenomic next-generation sequencing

Abstract

BackgroundExtraoral infection by Porphyromonas gingivalis (P. gingivalis) is extremely rare and challenging to diagnose because the fastidious pathogen is difficult to culture by traditional methods. We report the first case of a patient with multiple abscesses in muscles and the brain with dura empyema due to P. gingivalis, which was diagnosed by metagenomic next-generation sequencing (mNGS).Case presentationA 65-year-old male patient was admitted to our hospital for multiple lumps in his body. Brain magnetic resonance imaging (MRI) and lower-limb computed tomography (CT) revealed multiple abscesses in the brain and muscles. A diagnosis of P. gingivalis infection was made based on mNGS tests of blood, cerebrospinal fluid (CSF), and pus samples, as the traditional bacterial culture of these samples showed negative results. Target antibiotic therapy with meropenem and metronidazole was administered, and CT-guided percutaneous catheter drainage of abscesses in both thighs was performed. The size of muscle abscesses reduced significantly and neurological function improved. The patient was followed up for 4 months. No abscesses re-appeared, and the remaining abscesses in his backside and both legs were completely absorbed. He can speak fluently and walk around freely without any neurological deficits.ConclusionMetagenomic next-generation sequencing is helpful for early diagnosis and subsequent treatment of P. gingivalis-associated multiple abscesses.

Successful management of nasopharyngitis caused by <i>Schizophyllum commune</i> in a captive cheetah (<i>Acinonyx jubatus</i>)

“…This case study suggests that S. commune may cause granulomatous nasopharyngitis and surgical resection of the nodules, and subsequent medication with antifungal agents is the curative therapy for a captive cheetah. In this case, treatment with fluconazole was insufficient; in contrast, itraconazole exhibited a curative therapeutic effect, as suggested in previous studies [7,12,13]. However, the therapeutic effects of surgical treatment combined with antifungal medication remain unclear, and the relatively long-term remission of 73 days after fluconazole administration might have been due to the debulking of gross lesions.…”

“…The basidiomycete Schizophyllum commune is a common mushroom species that is isolated from various natural sources. However, it has been reported that the mushroom is occasionally responsible for infections in humans and animals [1,4,6,7,11,13]. In humans, S. commune infection has been reported as allergic bronchopulmonary mycosis, allergic fungal rhinosinusitis, and mucoid impaction of the bronchi [3,5,6,10].…”

“…Sequence similarity to these species was 100%. Of these, we considered that the cause of nasopharyngitis in this cheetah was S. commune based on the following reasons: M. restricta is yeast, 5 S. radula is the fungus that grows on woods and has not previously reported as the infection source for vertebrates, although it was not defined that S. commune is responsible for this disease because of lacking fungal culture [1,4,6,7,11,13].…”

Economic impact of metagenomic next-generation sequencing versus traditional bacterial culture for postoperative central nervous system infections using a decision analysis mode: study protocol for a randomized controlled trial

“…In designing this study, we considered that although the cost of mNGS detection is higher than that of pathogen culture, its shorter turnaround time for results facilitates early initiation of targeted treatment ( 20 – 22 ), potentially leading to significant reductions in medical costs and improved patient prognosis, thereby combining cost-effectiveness. Nathan A. Pennell et al suggested that “the use of second-generation sequencing may expand the number of patients undergoing testing for common and less common genetic mutations, providing physicians and patients with more information to make informed and timely treatment decisions.…”

Whole Genome Sequencing and Phenotypic Analysis of Antibiotic Resistance in Filifactor alocis Isolates

“…Other weapons in F. alocis’ arsenal include (1) the production of exotoxins, such as FtxA, which belongs to the RTX family and might help damage the surrounding cells by forming pores in the membranes of epithelial cells [ 13 ], (2) the ability to overcome oxidative stress thanks to enzymes such as superoxide reductase, which helps F. alocis to overcome the neutrophil response [ 14 ], and (3) the capability of mechanically adapting to the environment by forming pili-like projections [ 15 , 16 ]. To make things worse, and similar to other periodontopathogens such as Porphyromonas gingivalis , Fusobacterium nucleatum, and Aggregatibacter actinomycetemcomitans , F. alocis has also been detected in non-oral environments such as lung and brain abscesses [ 17 , 18 , 19 , 20 , 21 ].…”