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, Pneumonia, Sequence Analysis, DNA, acute respiratory distress syndrome
SARS-CoV-2/COVID-19
29 June 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936896
16 June 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936498
13 June 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936889
13 June 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936128
In Press
30 Jun 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936967
30 Jun 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936896
29 Jun 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936313
29 Jun 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.935242
Most Viewed Current Articles
23 Feb 2022 : Case report
DOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250
17 Feb 2022 : Case report
DOI :10.12659/AJCR.934399
Am J Case Rep 2022; 23:e934399
06 Dec 2021 : Case report
DOI :10.12659/AJCR.934406
Am J Case Rep 2021; 22:e934406
09 Feb 2022 : Case report
DOI :10.12659/AJCR.934744
Am J Case Rep 2022; 23:e934744