Use of 16s rRNA Gene Sequencing to Identify a Case ofPediococcus parvulusBacteremia in a Patient with Metastatic Testicular Cancer

Abstract

93Pediococcus is a gram-positive coccus that is facultatively anaerobic and catalase negative. It has been found in the food and wine industry. 1,2,3 There are 5 Pediococcus species described, 1,4,5 although the exact taxonomy is controversial. 4 Since the first report of infection by Pediococcus in 1987, 6 other cases involving this genus have been described involving either P. acidilactici or P. pentosaceum. 1,4 We present the first known case of Pediococcus parvulus (P. parvulus) infection in a young male with metastatic testicular cancer. Report of CaseA 22-year-old white male with metastatic testicular cancer was admitted to a local medical facility after developing fever, chills, abdominal pain, and dysuria for 3 days. Initial evaluation showed leukocytosis and positive abdominal computerized tomography (CT) scan findings. A retroperitoneal mass was observed with the presence of air, suggesting tumor necrosis and bowel perforation. Blood cultures were obtained prior to empiric antibiotic therapy with cephalothin, levofloxacin, and tobramycin. He was transferred to Creighton University Medical Center for surgical evaluation and further medical management. Past medical history was significant for stage III mature teratoma in the right testicle, with metastatic foci in the liver, lungs, and the retroperitoneal area. The retroperitoneal mass had a diameter of 20 cm and was in contact with the posterior wall of the second portion of the duodenum. He had a right orchiectomy and subsequent chemotherapy with etoposide, cisplatin, and bleomycin. He had his last chemotherapy infusion 10 days prior to the onset of symptoms. Complications derived from testicular cancer included the development of right hydronephrosis requiring ureteral stent placement, gastrointestinal bleeding secondary to retroperitoneal mass erosion into the duodenum, which was medically controlled, and central line-related sepsis with Enterococcus faecium and viridans group streptococci. On evaluation, he was tachycardic (104 beats per minute), and afebrile (temperature: 38.0ºC). He was in mild, generalized distress and had a cachectic appearance. He had facial pallor and diffuse abdominal pain on gentle palpation. The rest of