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

Abstract

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.

Peritonsillar abscess caused by Prevotella bivia during home quarantine for coronavirus disease 2019

“…In a systematic review of case rereports of P bivia infections, 19 cases were reported by 2021. Co-infection with other microorganisms was reported in seven cases and abscess occurred in seven of the 19 cases [6] . Thus, P bivia is predisposed to cause co-infection and form abscess.…”

“…Co-infection with other microorganisms was reported in seven cases and abscess occurred in seven of the 19 cases. [ 6 ] Thus, P bivia is predisposed to cause co-infection and form abscess. Some researchers have envisioned three bacterial/SARS-CoV-2 co-infections scenarios: (1) secondary SARS-CoV-2 infection following bacterial infection/colonization; (2) combined viral/bacterial pneumonia; and (3) secondary bacterial “superinfection” after SARS-CoV-2 infection.…”

Prevotella bivia: A Rare Cause of Zuska’s Breast Disease

“…Rare infections associated with Prevotella species include abscesses of the head and neck, otitis media, sinusitis, aspiration pneumonia, female genital tract infections, and intraabdominal infections [ 6 ]. Prevotella bivia is a rare cause of infection in the literature, with only 18 documented cases of infection globally, and the optimal antibiotic regimen reported from those cases varies widely [ 7 ]. Many of the cases were treated with multiple courses of different antibiotics, demonstrating the difficulty of properly treating infections caused by Prevotella bivia .…”

“…A common error in the management of nonpuerperal breast abscess is treatment with narrow-spectrum gram-positive antibiotics. This strategy excludes anaerobes, which contribute to a significant proportion of nonpuerperal breast abscesses, and may be a contributing factor in the high recurrence rates noted with such abscesses [ 7 ]. Consideration should be made for treatment with broad-spectrum antibiotics which target anaerobic and gram-positive bacteria, such as amoxicillin-clavulanate, or clindamycin.…”

Wiskott‐Aldrich syndrome diagnosed after cellulitis at the BCG vaccination site

“…In healthy individuals, Prevotella can cause pelvic infections and genital tract, chest wall, and breast abscesses. 4,5 Reports of Prevotella isolated and identified from infected sites in patients with WAS are lacking. Susceptibility to infection and closed space, created by ointment application in this case, is likely to have created an environment conducive to the growth of anaerobic bacteria; patients may present with prolonged skin lesions following BCG vaccination.…”