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Multifocal brain abscesses caused by invasive Streptococcus intermedia: A case report
Lin Yao1, Sansong Chen1, Zuan Yu1
1Department of Neurosurgery, The Translational Research Institute for Neurological Disorders, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China.
Abstract:
Multifocal brain abscesses caused by invasive Streptococcus intermedia are relatively rare. Here, we present a 67-year-old male was admitted to the hospital for unconsciousness and fever. The computed tomography (CT) examination showed multiple intracranial space-occupying and "cavity-like" changes in the right lower lung. The examination of cerebrospinal fluid (CSF) was consistent with typical bacterial meningitis, CSF analyses revealed leukocytosis (10,300 × 106/L), elevated protein levels (140.39 mg/dL), decreased glucose levels (0.27 mmol/L), and normal chloride concentration level (120.2 mmol/L), however, pathogens were not detected in the cultures. Then, the CSF and sputum samples were analyzed using meta-genomic next-generation sequencing (mNGS), and S. intermedia was detected in both samples. We adjusted the use of antibiotics according to the results of mNGS in time. After anti-infective treatment, the patient achieved good treatment results in a very short time. This case highlights the mNGS can identify pathogens of brain abscess, and provide strong evidence for clinical diagnosis and treatment strategy.
Insights
Multifocal brain abscesses caused by Streptococcus intermedia are rare. Meta-genomic next-generation sequencing (mNGS) identified the pathogen, enabling rapid, targeted antibiotic treatment and a successful patient recovery.
Area of Science:
- Neurology
- Infectious Diseases
- Medical Diagnostics
Background:
- Multifocal brain abscesses are uncommon neurological infections.
- Invasive *Streptococcus intermedia* is a rare causative agent of brain abscesses.
Observation:
- A 67-year-old male presented with unconsciousness and fever.
- CT revealed intracranial space-occupying lesions and lung changes.
- Cerebrospinal fluid analysis indicated bacterial meningitis but without pathogen detection in cultures.
Findings:
- Meta-genomic next-generation sequencing (mNGS) of CSF and sputum identified *S. intermedia*.
- Targeted antibiotic therapy based on mNGS results led to rapid clinical improvement.
Implications:
- mNGS is a valuable tool for identifying pathogens in brain abscesses.
- This technique aids in timely clinical diagnosis and effective treatment strategies.
- Early pathogen identification improves patient outcomes in complex infections.
