Refractory pneumonia caused by Prevotella heparinolytica: a case report.
Abstract: Prevotella heparinolytica is a Gram-negative bacterium that is commonly found in the oral, intestinal, and urinary tracts. It has been extensively studied in lower respiratory tract infections in horses, which has heparinolytic activity and can secrete heparinase and further induces virulence factors in cells and causes disease. However, no such cases have been reported in humans. Methods: A 58-year-old male patient from China presented to the respiratory clinic in Suzhou with a productive cough producing white sputum for 20 days and fever for 3 days. Prior to this visit, a chest computed tomography scan was conducted, which revealed multiple patchy nodular opacities in both lungs. On admission, the patient presented with a temperature of 38.1 °C and a pulse rate of 110 beats per minute. Despite routine anti-infective treatment with moxifloxacin, his temperature fluctuated and the treatment was ineffective. The patient was diagnosed with Prevotella heparinolytica infection through metagenomic next-generation sequencing. Therefore, the antibiotics were switched to piperacillin-tazobactam in combination with ornidazole, which alleviated his symptoms; 1 week after discharge, the patient returned to the clinic for a follow-up chest computed tomography, and the opacities on the lungs continued to be absorbed. Conclusions: Prevotella heparinolytica is an opportunistic pathogen. However, it has not been reported in human pneumonia. In refractory pneumonia, measures such as metagenomic next-generation sequencing can be used to identify pathogens and help guide antibiotic selection and early support.
© 2024. The Author(s).
Publication Date: 2024-04-30 PubMed ID: 38685076PubMed Central: PMC11059698DOI: 10.1186/s13256-024-04538-8Google Scholar: Lookup
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Summary
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Overview
- This case report describes a rare instance of pneumonia in a human caused by the bacterium Prevotella heparinolytica, which is usually found in animals and is not commonly known to infect humans.
- The study highlights the diagnosis, treatment, and successful management of refractory pneumonia with targeted antibiotics based on advanced genetic testing of pathogens.
Introduction to Prevotella heparinolytica
- Prevotella heparinolytica is a Gram-negative bacterium typically residing in the oral cavity, intestines, and urinary tract in humans and animals.
- It has heparinolytic activity, meaning it can break down heparin, a molecule involved in blood coagulation.
- In horses, this bacterium is linked to lower respiratory tract infections and is known to secrete heparinase, which increases its virulence and ability to cause disease.
- Prior to this report, no cases of human pneumonia caused by P. heparinolytica had been documented.
Case Details
- A 58-year-old Chinese male patient presented with a 20-day history of productive cough with white sputum, accompanied by fever for 3 days.
- Chest computed tomography (CT) imaging revealed multiple patchy nodular opacities in both lungs, indicating pneumonia.
- Vital signs on admission included a temperature of 38.1°C and a pulse rate of 110 beats per minute, indicating infection and systemic response.
- Initial treatment with the antibiotic moxifloxacin was unproductive, as symptoms and fever persisted, indicating refractory pneumonia.
Diagnostic Approach
- Conventional testing failed to identify the causative pathogen, necessitating more advanced diagnostic tools.
- Metagenomic next-generation sequencing (mNGS) was employed on respiratory samples to identify the microorganism.
- This approach detected Prevotella heparinolytica as the infectious agent, a novel finding in the context of human pneumonia.
Treatment and Outcome
- Following the mNGS results, the treatment was adjusted from moxifloxacin to a combination of piperacillin-tazobactam and ornidazole.
- This antibiotic regimen effectively controlled the infection, alleviating the patient’s symptoms.
- One week after discharge, follow-up chest CT showed continued resolution of lung opacities, indicating recovery.
Conclusions and Clinical Significance
- Prevotella heparinolytica, although typically considered an opportunistic pathogen, can cause refractory pneumonia in humans.
- This case underscores the importance of advanced pathogen identification techniques such as metagenomic next-generation sequencing for difficult-to-diagnose infections.
- Accurate pathogen identification allows for tailored antibiotic therapy, improving clinical outcomes in refractory pneumonia cases.
- Healthcare providers should consider atypical anaerobic pathogens like P. heparinolytica when managing unresolved lung infections, especially when initial treatments fail.
Cite This Article
APA
Sun J, Xu X, Gao S, Pan Q, Liu Z, Huang Y, Lian Y.
(2024).
Refractory pneumonia caused by Prevotella heparinolytica: a case report.
J Med Case Rep, 18(1), 213.
https://doi.org/10.1186/s13256-024-04538-8 Publication
Researcher Affiliations
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China. xuxun73@hotmail.com.
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China. lyx@suda.edu.cn.
MeSH Terms
- Humans
- Male
- Middle Aged
- Prevotella / isolation & purification
- Anti-Bacterial Agents / therapeutic use
- Tomography, X-Ray Computed
- Bacteroidaceae Infections / drug therapy
- Bacteroidaceae Infections / microbiology
- Bacteroidaceae Infections / diagnosis
- Pneumonia, Bacterial / drug therapy
- Pneumonia, Bacterial / microbiology
- Pneumonia, Bacterial / diagnosis
- Piperacillin, Tazobactam Drug Combination / therapeutic use
Grant Funding
- SYSD2019104 / Science and Technology Program of Suzhou
- SDFEYBS2002 / Second Affiliated Hospital of Soochow University
- SDFEYHT2224 / Second Affiliated Hospital of Soochow University
- YWJKJJHKYJJ-HX05 / Medical Science Research Funding Project of Beijing Medical Health Public Welfare Foundation
Conflict of Interest Statement
The authors declare that they have no competing interests.
References
This article includes 20 references
- Watanabe M, Tsuda H, Yamada S. Characterization of heparinase from an oral bacterium Prevotella heparinolytica.. J Biochem 1998;123(2):283–288.
- Ashimoto A, Flynn MJ, Slots J. Molecular genetic detection of Bacteroides heparinolyticus in adult periodontitis.. Oral Microbiol Immunol 1995;10(5):284–287.
- Kinoshita Y, Niwa H, Katayama Y, Hariu K. Dominant obligate anaerobes revealed in lower respiratory tract infection in horses by 16S rRNA gene sequencing.. J Vet Med Sci 2014;76(4):587–591.
- Bailey GD, Moore LVH, Love DN, Johnson JL. Bacteriodes heparinolyticus: deoxyribonucleic acid relatedness of strains from the oral cavity and oral-associated disease conditions of horses, cats, and humans.. Int J Syst Bacteriol 1988;38(1):42–44.
- Love DN, Johnson JL, Moore LV. Bacteroides species from the oral cavity and oral-associated diseases of cats.. Vet Microbiol 1989;19(3):275–281.
- Smith AJ, Greenman J, Embery G. Detection and possible biological role of chondroitinase and heparitinase enzymes produced by Porphyromonas gingivalis W50.. J Periodontal Res 1997;32(1):1–8.
- Sherrard LJ, Graham KA, McGrath SJ. Antibiotic resistance in Prevotella species isolated from patients with cystic fibrosis.. J Antimicrob Chemother 2013;68(10):2369–2374.
- Gu W, Deng X, Lee M. Rapid pathogen detection by metagenomic next-generation sequencing of infected body fluids.. Nat Med 2021;27(1):115–124.
- Chang C, Wang H, Zhang L. Clinical efficiency of metagenomic next-generation sequencing in sputum for pathogen detection of patients with pneumonia according to disease severity and host immune status.. Infect Drug Resist 2023;16:5869–5885.
- Yang A, Chen C, Hu Y. Application of metagenomic next-generation sequencing (mNGS) using bronchoalveolar lavage fluid (BALF) in diagnosing pneumonia of children.. Microbiol Spectr 2022;10(5):e01488.
- Racklyeft DJ, Love DN. Bacterial infection of the lower respiratory tract in 34 horses.. Aust Vet J 2000;78(8):549–559.
- Scannapieco FA, Cantos A. Oral inflammation and infection, and chronic medical diseases: implications for the elderly.. Periodontol 2000 2016;72(1):153–175.
- Debelian GJ, Olsen I. Systemic diseases caused by oral infection.. Clin Microbiol Rev 2000;13(4):547–548.
- Seymour GJ, Ford PJ, Cullinan MP. Relationship between periodontal infections and systemic disease.. Clin Microbiol Infect 2007;13(Suppl 4):3–10.
- Maurin M. Editorial: Insights in clinical microbiology: 2021.. Front Cell Infect Microbiol 2022;12:928344.
- Molina A, Huck O, Herrera D, Montero E. The association between respiratory diseases and periodontitis: a systematic review and meta-analysis. J Clin Periodontol. 2023;50(6):842–887. doi: 10.1111/jcpe.13767.
- Mammen MJ, Scannapieco FA, Sethi S. Oral–lung microbiome interactions in lung diseases. Periodontol 2000. 2020;83(1):234–241. doi: 10.1111/prd.12301.
- De Melo Neto JP, Melo MSAE, Dos Santos-Pereira SA, et al. Periodontal infections and community-acquired pneumonia: a case–control study. Eur J Clin Microbiol Infect Dis. 2013;32(1):27–32. doi: 10.1007/s10096-012-1710-y.
- Awano S, Ansai T, Takata Y, et al. Oral health and mortality risk from pneumonia in the elderly. J Dent Res. 2008;87(4):334–339. doi: 10.1177/154405910808700418.
- Imai K, Iinuma T, Sato S. Relationship between the oral cavity and respiratory diseases: aspiration of oral bacteria possibly contributes to the progression of lower airway inflammation. Jpn Dent Sci Rev. 2021;57:224–230. doi: 10.1016/j.jdsr.2021.10.003.
Citations
This article has been cited 1 times.- Wang J, Zhao Y, Wang P, Yu Y, Xu Y, Yang Y. Eimeria ovinoidalis Infection Reshapes Gut Microbial Communities and Metabolic Profiles in Tan Sheep.. Biology (Basel) 2025 Sep 4;14(9).
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