CLINICAL CASE
Identification of the atypical bacterial strain Streptococcus intermedius that caused brain abscess in the patient using Sanger sequencing of the 16S rRNA gene from the DNA extracted from a pus sample
1 Clinical Diagnostic Laboratory,Speransky Children's Clinical Hospital No. 9, Moscow, Russia
2 Laboratory of Pharmacogenomics,Institute of Chemical Biology and Fundamental Medicine of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
Correspondence should be addressed: Maria Gordukova
Shmitovsky proezd, d. 29, Moscow, Russia, 123317; ur.9-bkgd@avokudrog.am
All authors' contribution to this work is equal: selection and analysis of literature, research planning, data collection, analysis, and interpretation, drafting of a manuscript, editing.
In this article we present a clinical case of brain abscess in a girl aged 14 years and 11 months caused by a pathogen that could not be identified by routine microbiological testing. Before admission and during her stay in the hospital, the teenager did not have fever. Diagnosis and treatment were impeded by allergic responses to a wide range of antibiotics. The patient underwent three surgical interventions. Pus culture was performed 4 times, showing no growth. A PCR assay was run twice, but both times the results came out negative. Therefore, a decision was made to amplify and Sanger-sequence the 16S rRNA gene from the DNA extracted from patient’s pus. BLAST showed a 99 % homology of the obtained nucleotide sequence to the sequence of the 16S rRNA gene of Streptococcus intermedius (strain ChDC B589, KF733728.1) which had been previously shown to play a role in brain abscess development. Treatment ex juvantibus against the pathogen was started before sequencing results were available. The patient responded positively, the symptoms were alleviated and the condition improved. Thus, we conclude that in some cases sequencing may be the only diagnostic technique capable of identifying the pathogen.
Keywords: 16S rRNA, brain abscess, Streptococcus intermedius, Sanger sequencing, laboratory diagnostics