AUTHOR=Chen Minhua , Lai Zhiyi , Cheng Mingjun , Liang Tianyu , Lin Zongbin 

TITLE=Rare brain and pulmonary abscesses caused by oral pathogens started with acute gastroenteritis diagnosed by metagenome next-generation sequencing: A case report and literature review

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2022.949840

DOI=10.3389/fcimb.2022.949840

ISSN=2235-2988

ABSTRACT=Odontogenic brain and pulmonary abscess are an extremely rare infectious disease. It is mainly caused by upward or downward transmission of local infection or blood borne spread. In recent years, with the wide application of some novel testing methods in clinical practice, the diagnosis of unexplained infection such as odontogenic abscess in different organs has gradually become clear. We report a case of a 21-year-old male who was healthy and had not received any oral treatment before onset. He started with acute gastroenteritis related symptoms, then developed meningitis related symptoms seven days later with septic shock. No obvious abscess lesions were found on head computed tomography (CT) at admission, and the etiology was not clear by routine examination, which was very easy to be misdiagnosed as serious infection caused by intestinal pathogens. But odontogenic pathogens were found both in his blood and cerebrospinal fluid through metagenomic next generation sequencing (mNGS) analysis. Subsequently, rechecked imaging examination displayed multiple brain and pulmonary abscesses. Finally, it was diagnosed as odontogenic brain and pulmonary abscess. After a super long anti-infection course (13 weeks of intravenous antibiotics plus 2 weeks of oral antibiotics) and surgery, the patient was improved and discharged from the hospital. From this case, we could see the development of new diagnostic technologies such as mNGS plays an important role in the early and confirmed diagnosis of diseases previously difficult to diagnose such as odontogenic polymicrobial infections, and ultimately helps to improve the prognosis of these patients.