PYOPNEUMOTHORAX CAUSED BY PREVOTELLA INTERMEDIATA: AN INTERESTING CASE REPORT
DOI:
https://doi.org/10.55519/JAMC-03-13178Keywords:
Prevotella Intermediata, Pyopneumothorax, HRCT Chest, Tube Thoracostomy, Amoxicillin-Clavulanate, MetronidazoleAbstract
Prevotella species are usually seen in the intestinal tract including oral cavity as commensal bacteria and can lead to periodontal infections in immunocompetent patients. However, in patients who are immunocompromised, Prevotella can cause infections at other sites. A 35-year-old gentleman presented with 1-month history of high-grade fever and right sided pleuritic chest pain. On examination, he was in discomfort due to pain, with temperature 103 oF, pulse 104 beats per minute, blood pressure 130/90 mmHg, respiratory rate 22 breaths per minute and O2 saturation 94% on room air. Oral cavity revealed poor hygiene with left lower carious incisor. There was reduced chest expansion in right sub-scapular region with reduced vocal fremitus, dull percussion note, absent breath sounds and reduced vocal resonance. WBC count was raised at 43,600 per cm. X-ray followed by HRCT chest demonstrated peripheral opacifications with air-fluid level in right lower zone due to loculated pyopneumothorax and pleural thickening. Ultrasound guided chest tube thoracostomy in the loculated pyoneumothorax aspirated 1200 ml of foul-smelling reddish-tinged pus which revealed growth of anaerobic gram-negative rods of Prevotella Intermediata on culture, which was sensitive to amoxicillin-clavulanate and metronidazole. Work up of immunosuppressive causes was negative. The patient responded well to treatment and was asymptomatic at follow-up after 6 weeks.
References
Arumugam M, Raes J, Pelletier E, Le Paslier D, Yamada T, Mende DR, et al. Enterotypes of the human gut microbiome. Nature 2011;473(7346):174-80.
Sampaio-Maia B, Caldas IM, Pereira ML, Pérez-Mongiovi D, Araujo R. The Oral Microbiome in Health and Its Implication in Oral and Systemic Diseases. Adv Appl Microbiol 2016;97:171-210.
Watanabe T, Hara Y, Yoshimi Y, Fujita Y, Yokoe M, Noguchi Y. Clinical characteristics of bloodstream infection by Parvimonas micra: retrospective case series and literature review. BMC Infect Dis 2020;20(1):578.
Li Y, Yang J, Wang J, Wei B, Hu L. Pyopneumothorax caused by Parvimonas micra and Prevotella oralis: a case report. World J Emerg Med 2023;14(6):488-91.
Diesler R, Kiakouama-Maleka L. A challenging case of thoracic empyema caused by Prevotella spp. Respir Med Case Rep 2021;35:101567.
Shen KR, Bribriesco A, Crabtree T, Denlinger C, Eby J, Eiken P, et al. The American Association for Thoracic Surgery consensus guidelines for the management of empyema. J Thorac Cardiovasc Surg 2017;153(6):e129-46.
Addala DN, Bedawi EO, Rahman NM. Parapneumonic Effusion and Empyema. Clin Chest Med 2021;42(4):637-47.
Sorino C, Mondoni M, Lococo F, Marchetti G, Feller-Kopman D. Optimizing the management of complicated pleural effusion: From intrapleural agents to surgery. Respir Med 2022;191:106706.
Hassan M, Patel S, Sadaka AS, Bedawi EO, Corcoran JP, Porcel JM. Recent Insights into the Management of Pleural Infection. Int J Gen Med 2021;14:3415-29.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Abdul Samad, Farah Naz, Nauman Ismat Butt, Sajjad Sarwar, Muhammad Sohail Ajmal Ghoauri, Ayesha Zahid
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.