26 November 2018 : Case report
Improved Detection of Culprit Pathogens by Bacterial DNA Sequencing Affects Antibiotic Management Decisions in Severe Pneumonia
Unusual clinical course, Mistake in diagnosis
Daniel G. Dunlap12ABCDEF*, Christopher W. Marshall3ABCDE, Adam Fitch2ABCDE, Sarah F. Rapport4ABDE, Vaughn S. Cooper3ABCDE, Bryan J. McVerry42ABCDEFG, Alison Morris425ABCDEFG, Georgios D. Kitsios42ABCDEFGDOI: 10.12659/AJCR.912055
Am J Case Rep 2018; 19:1405-1409
Abstract
BACKGROUND: Severe pneumonia requiring admission to an intensive care unit carries high morbidity and mortality. Evidence-based management includes early administration of empiric antibiotics against plausible bacterial pathogens while awaiting results of microbiologic cultures. However, in over 60% of pneumonia cases, no causative pathogen is identified with conventional diagnostic techniques. In this case report, we demonstrate how direct-from-sample sequencing of bacterial DNA could have identified the multiple culprit pathogens early in the disease course to guide appropriate antibiotic management.
CASE REPORT: A previously healthy, 21-year-old man presented with neck pain and fever and rapidly developed acute respiratory distress syndrome (ARDS) requiring mechanical ventilation. He was started on broad-spectrum antibiotics and was found to have septic thrombophlebitis of the left internal jugular vein (Lemierre syndrome), with blood cultures growing Fusobacterium necrophorum. While his antibiotics were narrowed to piperacillin-tazobactam monotherapy, his clinical condition worsened, but repeated efforts to define an additional/alternative respiratory pathogen resulted in negative cultures. He eventually developed bilateral empyemas growing Mycoplasma hominis. Once azithromycin was added to the patient’s regimen, he improved dramatically. Retrospective sequencing of consecutive endotracheal aspirates showed Fusobacterium as the dominant pathogen early in the course, but with significant and increasing Mycoplasma abundance several days prior to clinical detection.
CONCLUSIONS: Had sequencing information been available to the treating clinicians, the causative pathogens could have been detected earlier, guiding appropriate antibiotic therapy and perhaps preventing his clinical complications. Real-time bacterial DNA sequencing has the potential to shift the diagnostic paradigm in severe pneumonia.
Keywords: Lemierre Syndrome, Sequence Analysis, DNA, acute respiratory distress syndrome
In Press
19 Mar 2024 : Case report
Excimer Laser Therapy for Pigmented Purpuric Dermatosis: A Case StudyAm J Case Rep In Press; DOI: 10.12659/AJCR.942853
19 Mar 2024 : Case report
Case Report: Primary Cutaneous Histoplasmosis in an Immunocompetent Patient After Cosmetic Injection of Pla...Am J Case Rep In Press; DOI: 10.12659/AJCR.942660
19 Mar 2024 : Case report
Bilateral Simultaneous Basal Ganglia Hemorrhage: A Case ReportAm J Case Rep In Press; DOI: 10.12659/AJCR.943174
19 Mar 2024 : Case report
Medial Hoffa Fracture: A Case Report and Literature Review of Approach and ManagementAm J Case Rep In Press; DOI: 10.12659/AJCR.943136
Most Viewed Current Articles
07 Mar 2024 : Case report
Neurocysticercosis Presenting as Migraine in the United StatesDOI :10.12659/AJCR.943133
Am J Case Rep 2024; 25:e943133
10 Jan 2022 : Case report
A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...DOI :10.12659/AJCR.935263
Am J Case Rep 2022; 23:e935263
19 Jul 2022 : Case report
Atlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19DOI :10.12659/AJCR.936128
Am J Case Rep 2022; 23:e936128
23 Feb 2022 : Case report
Penile Necrosis Associated with Local Intravenous Injection of CocaineDOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250