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Choroid plexitis caused by Burkholderia cepacia complex after COVID-19
Masamune Kimura1, Satoru Fujiwara2, Hirokazu Kuroda3
1Kobe City Medical Center General Hospital, Department of Neurology, Kobe, Japan; Kobe University Graduate School of Medicine, Division of Neurology, Kobe, Japan.
Abstract:
Burkholderia cepacia complex (BCC) encompasses opportunistic pathogen with various clinical manifestations ranging from no symptoms to severe respiratory infections and septicemia. Central nervous system infections caused by BCC are rare. To the best of our knowledge, we present the first reported case of choroid plexitis caused by BCC after severe COVID-19. A 67-year-old woman who had been previously diagnosed with COVID-19 presented with a mild fever and headache. Gadolinium-enhanced T1-weighted brain magnetic resonance imaging showed contrast effects in the right choroid plexus and encapsulated abscess. Gram staining of cerebrospinal fluid revealed the presence of gram-negative rods. Broad-range polymerase chain reaction amplification of 16S ribosomal RNA from the cerebrospinal fluid, followed by sequence analysis, identified BCC; thus, choroid plexitis caused by BCC was diagnosed. After prolonged antimicrobial treatment with a multiantibiotic regimen, the patient recovered completely. This case highlights the importance of long-term therapy with a carefully selected multiantibiotic regimen to achieve complete recovery after BCC infection.
Insights
This study reports the first case of central nervous system infection, specifically choroid plexitis, caused by Burkholderia cepacia complex (BCC) in a patient recovering from severe COVID-19. Prompt diagnosis and prolonged multi-antibiotic therapy led to complete recovery.
Area of Science:
- Infectious Diseases
- Neurology
- Microbiology
Background:
- The Burkholderia cepacia complex (BCC) comprises opportunistic pathogens causing diverse infections.
- Central nervous system (CNS) infections due to BCC are infrequently reported.
- Severe COVID-19 can predispose individuals to secondary opportunistic infections.
Observation:
- A 67-year-old woman with a history of severe COVID-19 presented with fever and headache.
- Brain MRI revealed contrast enhancement in the choroid plexus and an abscess.
- Cerebrospinal fluid analysis identified gram-negative rods, later confirmed as BCC via 16S rRNA sequencing.
Findings:
- The patient was diagnosed with choroid plexitis and CNS abscess caused by Burkholderia cepacia complex.
- Diagnosis was confirmed through Gram staining and 16S ribosomal RNA gene sequencing of cerebrospinal fluid.
- The patient received prolonged antimicrobial treatment with a carefully selected multi-antibiotic regimen.
Implications:
- This case represents the first documented instance of choroid plexitis caused by BCC following severe COVID-19.
- Highlights the potential for rare opportunistic CNS infections in post-COVID-19 patients.
- Emphasizes the necessity of extended, targeted antimicrobial therapy for successful treatment of BCC CNS infections.
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