Polymicrobial Anaerobic Meningitis Detected by Next-Generation Sequencing: Case Report and Review of the Literature

Abstract

BackgroundAnaerobic meningitis is a severe central nervous system infection associated with significant neurological sequelae and high mortality. However, the precise detection of causative pathogen(s) remains difficult because anaerobic bacteria are difficult to culture. Next-generation sequencing is a technology that was developed recently and has been applied in many fields. To the best of our knowledge, the use of next-generation sequencing for cerebrospinal fluid analysis in the diagnosis of anaerobic meningitis has been rarely reported.Case presentationHere, we report a case of polymicrobial anaerobic meningitis diagnosed using next-generation sequencing of cerebrospinal fluid in a 16-year-old girl. Five species of anaerobic bacteria (Porphyromonas gingivalis, Prevotella enoeca, Campylobacter rectus, Fusobacterium uncleatum, and Actinomyces israelii) were detected by next-generation sequencing and treated with antibacterial agents (ceftriaxone, vancomycin, and metronidazole). The patient responded well to antibacterial treatment. Further inspection revealed bone destruction at the base of the skull, which further confirmed that these bacteria had originated from the oral cavity. One month later, the patient's condition improved significantly. At the same time, we performed a literature review on anaerobic meningitis using studies published in the last 20 years.ConclusionsThis case emphasizes the importance of applying metagenomic next-generation sequencing to clinch the clinical diagnosis for patients with central nervous system infection. Metagenomic next-generation sequencing has been reported to be an important diagnostic modality for identifying uncommon pathogens.

Polymicrobial Bacterial Meningitis in a Patient with Chronic Suppurative Otitis Media: Case Report and Literature Review

“…Most of the cases and studies performed previously in our hospital identified only mono-bacterial anaerobe meningitis [ 36 , 37 ]. Moreover, only a few case reports of polymicrobial mixed aerobe–anaerobe meningitis have been published worldwide [ 1 , 33 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ].…”

“…Polymicrobial meningitis including anaerobes is very rare nowadays, but was reported in the past as a complication in ear–nose–throat (ENT), abdominal, or gynecological infections, or other rare clinical malformations, such as Currarino syndrome (characterized by the triad of sacral anomaly, anorectal malformation, and presacral mass) [ 1 , 2 ]. Of these, otolaryngological infections are a known predisposing factor mainly for anaerobic meningitis [ 3 ].…”

“…Chronic suppurative otitis media (CSOM) is a common complication of brain abscess, meningitis, and lateral sinus thrombophlebitis, the prevalence of all intracranial complications being 0.17% and the mean age 5–10 years old, most cases being reported in the pediatric population [ 4 ]. In addition, anaerobic meningitis accounts for only 2.4% of all bacterial meningitis but can be severe and its central nervous system injury is associated with significant neurological sequelae and high mortality [ 1 , 5 ].…”

“…Central nervous system infections due to common flora anaerobic organisms have been described before only in case reports [ 6 ]. Due to difficulties in the isolation of these pathogens, the true incidence of these infections is underestimated [ 1 ]. Within the normal oral flora, Streptococcus spp., Prevotella spp., Peptostreptococcus spp., Porphyromonas , and Fusobacterium spp.…”

Brain abscess of odontogenic origin: A case report and literature review

“…Several papers have shown that. [ 23 , 24 ] For infections of unknown origin, mNGS has expanded the bacterial detection spectrum and is a vital detection method. It is widely used in the early diagnosis and precise treatment of clinical infectious diseases.…”