DETECTION OF FUSOBACTERIAL INFECTION IN A CULTURE-NEGATIVE BRAIN ABSCESS WITH 16S rRNA GENE PCR
Dr. Christini Kortsalioudaki
United Kingdom 
12 slide(s) – English – 2011-06-07
DETECTION OF FUSOBACTERIAL INFECTION IN A CULTURE-NEGATIVE BRAIN ABSCESS WITH 16S rRNA GENE PCR
C Kortsalioudaki1, N Costa-Fernandes1, S Laurent1
1. Department of Paediatrics, Barnet General Hospital, London
Background and aims:
We report a case of Fusobacterium mastoiditis complicating brain abscess, in a healthy child.
Methods:
A 13 month-old girl presented with a 3-week history of right-ear discharge and pyrexia. She had already received 3 different courses of oral antibiotics following reviews in primary care. Examination revealed drowsiness and lethargy, left-sided gaze, hoarse voice, and increased muscle tone with opisthotonus. Mucopurulent pus was discharging from the right ear-canal. GCS was fluctuating between 12-14/15. An ear-swab obtained a week before, showed polymicrobic growth.An urgent CT revealed a rim-enhancing lesion within the right-cerebellar hemisphere, with skull disruption and bony destruction within the temporal and mastoid bone. There was mass effect with compression of the 4th ventricle and dilatation of the 3rd and lateral ventricles.
Results:
Ceftriaxone and Metronidazole were commenced and she was treansferred for neurosurgical care. The abscess was drained and same antibiotic-regimen was continued with significant clinical improvement within 48-hours.Pus cultures were negative however bacterial 16-S-rRNA gene-PCR detected presence of Fusobacterium species. A 4-weeks course of the above antibiotics was administered. A repeat brain-MRI revealed residual collection an additional 2-weeks of IV antibiotics was continued, followed by 2-weeks of oral Linezolid.
Conclusions:
Fusobacterial invasive infections are rare in children. Usually these patients have received 1-2 courses of oral antibiotics and the likelihood of pathogen isolation is very difficult.The use of 16SrRNA gene-PCR is of vital importance in these cases. Combined surgical and antimicrobial therapy is associated with recovery. However the appropriate duration of antimicrobial therapy remains unclear.
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