A Case of Culture-negative Brain Abscess Caused by Streptococcus intermedius Infection Diagnosed by Broad-range PCR of 16S Ribosomal RNA Nobuyuki Ohara 1 , Katsunori Asai 2,3 , Kiyofumi Ohkusu 4 , Akatsuki Wakayama 2 1Department of Neurology, Osaka Neurological Institute 2Department of Neurosurgery, Osaka Neurological Institute 3Department of Neurosurgery, Kobe City Medical Center General Hospital 4Department of Microbiology, Gifu University Graduate School of Medicine Keyword: brain abscess , Streptococcus intermedius , broad-range PCR , 16S ribosomal RNA pp.1199-1203
Published Date 2013/10/1
DOI https://doi.org/10.11477/mf.1416101620
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 A 50-year-old man presented with altered mental status during hospitalization for pneumonia. MRI showed multifocal ring-enhanced lesions, which consisted of multiple cerebral abscesses. We started empirical antibiotic therapy, but the following morning, his condition rapidly deteriorated and a CT scan revealed acute hydrocephalus, which required ventricular drainage. Gram staining of cerebro-spinal fluid from the ventricular drainage showed gram-positive cocci in chains, but culture results were negative. 16S ribosomal RNA sequencing with broad-range PCR of the cerebro-spinal fluid identified Streptococcus intermedius. On the basis of this identification, the antibiotic regimen was changed to ampicillin monotherapy. After 1 year of antibiotic therapy, all the abscesses had disappeared and the patient was discharged without any sequelae. Bacterial 16S rRNA gene analysis with broad-range PCR is a very useful method for facilitating the etiological diagnosis and selection of appropriate treatment for culture-negative infections. (Received: April 30, 2013, Accepted: June 11, 2013)

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