Rare brain and pulmonary abscesses caused by oral pathogens started with acute gastroenteritis diagnosed by metagenome next-generation sequencing: A case report and literature review

Abstract

Odontogenic brain and pulmonary abscesses are extremely rare infectious diseases. It is mainly caused by the upward or downward transmission of local infection or blood-borne spread. In recent years, with the wide application of some novel testing methods in clinical practice, the diagnosis of unexplained infections such as odontogenic abscesses in different organs has gradually become clear. We report a case of a 21-year-old male who was healthy and had not received any oral treatment before onset. He started with acute gastroenteritis-related symptoms, then developed meningitis-related symptoms seven days later with septic shock. No obvious abscess lesions were found on head computed tomography (CT) at admission, and the etiology was not clear by routine examination, which was very easy to misdiagnose as a serious infection caused by intestinal pathogens. But odontogenic pathogens were found both in his blood and cerebrospinal fluid through metagenomic next-generation sequencing (mNGS) analysis. Subsequently, rechecked imaging examination displayed multiple brain and pulmonary abscesses. Finally, it was diagnosed as an odontogenic brain and pulmonary abscess. After an extremely lengthy anti-infection course (13 weeks of intravenous antibiotics plus 2 weeks of oral antibiotics) and surgery, the patient was improved and discharged from the hospital. From this case, we could see that the development of new diagnostic technologies such as mNGS plays an important role in the early and confirmed diagnosis of diseases previously difficult to diagnose such as odontogenic polymicrobial infections and ultimately helps to improve the prognosis of these patients.

Lung abscess: an update on the current knowledge and call for future investigations

“…Numerous case reports have been published, for instance cases describing the clinical course of patients with Lemierre's syndrome [19 ▪ ] or granulomatosis with polyangiitis [23 ▪ ,24 ▪ ,25 ▪ ] highlighting the many differential diagnoses to consider. A few case reports also described new diagnostic tools including radiomics and metagenomic NGS [29 ▪ ,35 ▪ ,36 ▪ ,37 ▪ ] which could inspire future studies. Regarding treatment, a few case reports have described new intervention techniques and treatment options [41 ▪ ,42 ▪ ].…”

“…However, identifying the pathogens is often difficult, with positive sputum cultures in only around 50% [17,34]. Metagenomic NGS offers the possibility of identifying pathogens in cases with false-negative cultures [35 ▪ ,36 ▪ ]. In addition, this method is able to distinguish infection from colonization which could support clinical management and antimicrobial stewardship [37 ▪ ].…”

Case Report: A rare case of intramedullary spinal cord abscess with brain abscess caused by Klebsiella pneumoniae underwent surgical intervention

“…The application of mNGS in clinical laboratories for unbiased culture-independent diagnosis is increasingly noteworthy ( 9 , 10 ). CNS infections often manifest insidiously and can be accurately diagnosed using mNGS applied to CSF or biopsy specimens ( 11 – 13 ). We hypothesized that the patient might have acquired Klebsiella pneumoniae infection in the CNS as a result of partial destruction of paravertebral tissues caused by tuberculosis, followed by subsequent dissemination of the infection to adjacent tissues and CSF.…”

A Case Report of Brain abscess due to Prevotella oris and Review of the Literature

“…Cases of intracranial infection caused by Prevotella oris are very rare, we searched PubMed for English articles using the terms "Prevotella oris and brain abscess" and "brain abscess and Bacteroides oris/oralis". A total of 6 articles with detailed case-speci c information were identi ed, including 7 cases, are described in Table 1 [2,[8][9][10][11][12] . In previous case reports, most of them were brain abscesses con rmed by brain CT.…”