Journal Article

Case report of Actinomyces turicensis meningitis as a complication of purulent mastoiditis

Tiszlavicz, Zoltán, Jakab, Gabriella, Brassay, Réka, Szabó, Dóra, Kocsis, Béla, Orbán, Márton, Sárkány, Ágnes

2018

Overview

Background Central nervous system (CNS) infections caused by Actinomyces spp . including brain abscess, actinomycoma, subdural empyema and epidural abscess are well described, however reports of Actinomyces-associated meningitis are scarcely reported. Case report We present the case of a 43-year-old Hungarian male patient with poor socioeconomic status who developed acute bacterial meningitis caused by Actinomyces turicensis originating from the left side mastoiditis. The bacterial cultures of both cerebrospinal fluid (CSF) and purulent discharge collected during the mastoid surgery showed slow growing Gram-positive rods that were identified by automated systems (API, VITEK) as A. turicensis The bacterial identification was confirmed by 16S rRNA PCR and subsequent nucleic acid sequencing. No bacterial growth was detected in blood culture bottles after 5 days of incubation. Hence, multiple antibacterial treatments and surgical intervention the patient passed away. Conclusions Anaerobes are rarely involved in CNS infections therefore anaerobic culture of CSF samples is routinely not performed. However, anaerobic bacteria should be considered as potential pathogens when certain risk factors are present, such as paranasal sinusitis, mastoiditis in patients with poor socioeconomic condition. To the best of our knowledge, our case report is the first description of A. turicensis meningitis that has been diagnosed as consequence of purulent mastoiditis.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Actinomyces / Actinomyces - genetics / Actinomyces - isolation & purification / Actinomyces turicensis / Actinomycosis - complications / Adult / Anaerobes / Anaerobic bacteria / Anaerobic culture / Anti-Bacterial Agents - therapeutic use / Bacteria / Bacterial and fungal diseases / Blood culture / Brain / Brain Abscess - cerebrospinal fluid / Brain Abscess - drug therapy / Brain Abscess - microbiology / Case Report / Case reports / Case studies / Central nervous system / Cerebrospinal fluid / Culture / Empyema / Empyema, Subdural - cerebrospinal fluid / Empyema, Subdural - drug therapy / Empyema, Subdural - microbiology / Fatal Outcome / Glucose / Humans / Identification / Infectious Diseases / Internal Medicine / Laboratories / Liquor / Male / Mastoiditis / Mastoiditis - cerebrospinal fluid / Mastoiditis - complications / Mastoiditis - drug therapy / Mastoiditis - microbiology / Medical Microbiology / Medicine / Medicine & Public Health / Meningitis / Meningitis, Bacterial - cerebrospinal fluid / Meningitis, Bacterial - drug therapy / Meningitis, Bacterial - microbiology / Nervous system / Neutrophils / Nucleic acids / Parasitology / Polymerase Chain Reaction / Poor socioeconomic condition / Poverty / Proteins / Risk analysis / Risk factors / RNA, Ribosomal, 16S - genetics / Rods / rRNA 16S / Sinusitis / Social Class / Socioeconomic factors / Socioeconomics / Streptococcus infections / Subdural empyema / Surgery / Tropical Medicine