Diagnosis of an Acinetobacter pittii from a patient in China with a multiplex PCR-based targeted gene sequencing platform of the cerebrospinal fluid: A case report with literature review

Abstract

Background: The traditional diagnosis model has great challenges for the etiological diagnosis of the central nervous system (CNS) diseases with similar clinical manifestations, especially for the diagnosis of rare pathogens. It is very important to make rapid and accurate identification of pathogens for guiding clinical choices in administering countermeasures. Case summary: On August 22, 2020, a 49 years old Chinese male patient had a headache for two days, and then the computed tomography (CT) scan of the brain showed subarachnoid hemorrhage. Subsequently, he underwent twice craniotomy and about 3 weeks of hospitalization. Since September 20, the patient was in the local rehabilitation hospital for hyperbaric oxygen therapy for about three weeks. Then the patient developed acute purulent meningoencephalitis. In the absence of diagnosis of specific pathogenic bacteria, vancomycin (1 g every 12 hours), ceftazidime (2 g every 8 hours), mannitol dehydration (125 mL, every 8 hours), and sodium valproate (0.4 g tid) was used timely according to cerebrospinal fluid (CSF) examination and clinical manifestations. CSF smear and routine culture test were negative during hospitalization. We used the metagenomic next-generation sequencing (mNGS) analysis of CSF for quick and accurate diagnosis, which identified human herpesvirus type 4 (EBV), Corynebacterium corynebacterium , Achromobacter xylose oxidation, and Acinetobacter baumannii , But the mapping degree was not high. Then, we used the modified method-multiplex PCR-based targeted gene sequencing platform (ptNGS) to detect CSF samples and found that the sequences detected were Acinetobacter pittii ( A. pittii ) and Staphylococcus epidermidis . S. epidermidis might come from skin colonization during lumbar puncture, so it was excluded from the etiological diagnosis. Therefore, we highly suspected that A. pittii was the pathogen in this case. After about three weeks of hospitalization treatment, the patient’s symptoms were relieved. Conclusion: In conclusion, empirical medication before the identification of pathogens is very important. The ptNGS may be an effective method for the diagnosis of pathogens.

A case of explosive community-acquired pneumonia and septic shock caused by Acinetobacter pitti

“…According to the guidelines for severe community-acquired pneumonia [10], carbapenems combined with quinolones for anti-infection can be selected for treatment.Due to community onset and progressive platelet decline, gram-negative bacterial infection was considered rst. Empipenem and cilastatin, piperacillin and tazobactam combined with moxi oxacin were empirically treated for anti-infection and full uid resuscitation, and the disease was signi cantly alleviated.There is no clear laboratory evidence to determine the cause of the subsequent convulsions and void-like changes in lung imaging in the patient, and we speculate that they may be related to Acinetobacter pitti [11][12][13].…”

Diagnostic Performance of central nervous system infections in patients with neurosurgical intensive care using metagenomic next-generation sequencing: A Prospective Observational Study

“…Because the clinical manifestations of CNSIs in patients after neurosurgical operations often overlap with surgical disturbance, bleeding, and other inflammatory reactions, the diagnosis of CNSIs is more challenging and fully rely on the pathogen detection. Bacteriological culturing of a CSF sample (6,7) is considered as a gold standard for diagnosing CNSIs after neurosurgical surgery. However, in CSF samples, the pathogen load could be low after pre-operative antimicrobial therapy, with a positive detection rate of only approximately 7% (8,9).…”