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
Case report
Efficacy of Cold Atmospheric Plasma in Chronic Diabetic Foot Ulcer Management: A Case ReportAm J Case Rep In Press; DOI: 10.12659/AJCR.945462
Case report
Uncommon Cardiac Perforation and Lead Displacement After Pacemaker Implantation: A Case Study and Diagnosti...Am J Case Rep In Press; DOI: 10.12659/AJCR.945008
Case report
Diagnostic Challenges in Malignant Hyperthermia and Anesthesia-Induced Rhabdomyolysis: A Case StudyAm J Case Rep In Press; DOI: 10.12659/AJCR.946306
Case report
Complex Organ Injury Management in Abdominal Trauma: Case of a Heavy Iron Plate AccidentAm J Case Rep In Press; DOI: 10.12659/AJCR.945981
Most Viewed Current Articles
21 Jun 2024 : Case report 78,462
Intracranial Parasitic Fetus in a Living Infant: A Case Study with Surgical Intervention and Prognosis Anal...DOI :10.12659/AJCR.944371
Am J Case Rep 2024; 25:e944371
07 Mar 2024 : Case report 46,330
Neurocysticercosis Presenting as Migraine in the United StatesDOI :10.12659/AJCR.943133
Am J Case Rep 2024; 25:e943133
10 Jan 2022 : Case report 33,075
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
23 Feb 2022 : Case report 21,596
Penile Necrosis Associated with Local Intravenous Injection of CocaineDOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250