A case analysis of intracranial infection of Porphyromonas gingivalis

A case analysis of intracranial infection of Porphyromonas gingivalis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report A case analysis of intracranial infection of Porphyromonas gingivalis yuqiwang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4230089/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract OBJECTIVE A case of intracranial infection caused by Porphyromonas gingivalis was analyzed to provide evidence for clinical treatment. METHODS In one patient with intracranial infection, the results of multiple blood culture and cerebrospinal fluid culture were negative, and no pathogenic bacteria were found. Porphyromonas gingivalis in cerebrospinal fluid was determined by macrogene detection method, and the empirical selection of vancomycin combined with ceftriaxone anti-infection treatment was converted to metronidazole target treatment. RESULTS After 4 weeks of treatment, the patients recovered completely, and the laboratory examination indexes were normal. The results of brain CT and cerebrospinal fluid metagene test were negative. CONCLUSION For intracranial infection caused by rare microorganisms, under the premise of negative results of classical bacterial culture, advanced macrogene sequencing method can be used to determine pathogens, providing rapid and accurate detection results for clinical treatment. Subject classification codes: include these here if the journal requires them Infectious Diseases porphyromonas gingivalis pharmaceutical care metagenomic sequencing Figures Figure 1 Figure 2 Introduction Intracranial infections are prevalent in neurology and can lead to increased patient disability and mortality rates if left untreated [ 1 ] . Early diagnosis and treatment is important to improve the prognosis of patients [ 2 ] . Cerebrospinal fluid pathogenesis and associated biomarker testing are decisive in confirming the diagnosis of intracranial infections. The gold standard for cerebrospinal fluid culture is traditional methods, but the positive rate is low [ 3 ] and results take a long time to obtain. Typically [ 4 ] , it takes 3–5 days to produce results, which can cause a delay in guiding clinical diagnosis and targeted antibacterial therapy. The field of infection has seen a surge in interest in metagenomic next-generation sequencing due to the continuous development of molecular diagnostic techniques. This technique is particularly useful in detecting rare diseases and special pathogens, and can serve as an important tool for clinical screening of infectious diseases. The most common bacteria causing intracranial infections are Gram-positive cocci, such as Staphylococcus aureus, Enterococcus, MASR, and coagulase-negative Staphylococcus, as well as Acinetobacter baumannii, Enterobacteriaceae, Pseudomonas aeruginosa, Klebsiella pneumoniae, and others [ 5 ] . Patients with rare pathogenic bacterial infections may present negative cerebrospinal fluid (CSF) culture results, which can complicate clinical treatment. This case report presents a patient with intracranial infection caused by Porphyromonas gingivalis, detected through DNA-pathogen microorganism metagenome. This finding provides valuable information for clinical diagnosis and treatment. Display quotations of over 40 words, or as needed. Case presentation The hospital admitted a 49-year-old female patient on March 5, 2022 due to a persistent headache lasting for over one month and worsening for more than ten days. The patient's symptoms were: scraping-like pain on the left side of the head at first, which lasted for 2–3 hours to be relieved each time, and then turned to acupuncture-like pain all over the head, and the duration of the pain was longer than before, accompanied by swelling and pain in both eyes and tears. The discomfort was obvious on the left side, with blurred vision, double vision, nausea, and vomiting. The vomitus was stomach contents. He was admitted to the outpatient clinic with "painful ophthalmoplegia". After admission, the patient developed headache, accompanied by swelling and pain in both eyes, discomfort with tearing, and his left eye was closed and unable to open. The doctor gave methylprednisolone sodium succinate shock treatment based on the patient's condition and vital signs. On the evening of March 11, the patient's fever persisted, with a body temperature as high as 39.3°C. A clinical pharmacist was invited for consultation. The consultation opinion was that common Gram-positive and negative bacteria in intracranial infections should be considered. According to the "ESCMID Guidelines: Diagnosis and Treatment of Acute Bacterial Meningitis" Treatment"[6], vancomycin hydrochloride combined with ceftriaxone was used for anti-infective treatment. The efficacy of antibacterial drugs is evaluated 48–72 hours after administration. When the patient's fever and body temperature exceeds 38.5°C, bilateral venous blood samples are taken for bacterial culture and drug sensitivity testing. After the test results are reported, the antibacterial drug treatment plan is adjusted based on the results. On March 13, the patient suffered from intermittent and unbearable pain in his head, and the anti-infective treatment effect was not good. Considering that the patient's condition was serious, ceftriaxone was empirically switched to meropenem for anti-infective treatment. Multiple cerebrospinal fluid cultures and blood cultures were negative, so he was replaced. After taking meropenem, routine and biochemical tests of cerebrospinal fluid were reviewed, which showed that the infection indicators were lower than before, and the symptoms of headache and fever were not significantly relieved. The antibacterial spectrum of meropenem covers anaerobic bacteria, and it is considered that the blood concentration of the drug that may enter the cerebrospinal fluid cannot reach the level. Effective therapeutic concentration. During intracranial infection, lactic acid in cerebrospinal fluid increases significantly, pH decreases, and the increase in protein content reduces the free concentration of antibacterial drugs, affecting the binding of meropenem to proteins, thereby reducing antibacterial activity. The clinical pharmacist recommended that the bedside doctor communicate with the family members and obtain their consent before collecting cerebrospinal fluid samples for DNA-pathogen metagenomic testing. The result suggested: Porphyromonas gingivalis. Based on the patient's clinical symptoms, laboratory test results and anti-infective treatment effects, Porphyromonas gingivalis was determined to be the pathogenic bacteria. The clinical pharmacist consultation recommended that meropenem be discontinued and replaced with metronidazole and sodium chloride injection, and empirical treatment be given. Switch to targeted treatment. Although the patient's clinical symptoms improved after 2 weeks of treatment with metronidazole, they were not completely cleared. The routine and biochemical results of cerebrospinal fluid were still abnormal. After consultation, the clinical pharmacist recommended the addition of vancomycin and meropenem. After 4 weeks of treatment, the patient's clinical symptoms improved. disappear. After discharge, the results of intracranial CT and DNA-pathogen metagenomic testing were negative. The patient was followed up one month later and found no discomfort such as headache, nausea, and vomiting. Figures 1 and 2 show the CSF routine and biochemical results during treatment. Diagram1: Results of biochemical examination of cerebrospinal fluid Diagram2: results of routine cerebrospinal fluid examination Discussion (1) Porphyromonas gingivalis is a non-glycolytic, gram-negative, anaerobic bacterium and an important periodontal pathogen. It commonly colonizes the oral cavity and primarily affects individuals with low immunity or special populations. The relevant domestic and foreign literature was reviewed, and it was found that intracranial infection caused by Porphyromonas gingivalis, excluding oral diseases, is rarely reported both domestically and internationally. This infection is also a significant factor in the development of other diseases such as thrombosis, myocardial infarction, diabetes, endocarditis, coronary heart disease, atherosclerosis, and cerebral infarction [ 7 ] . Porphyromonas gingivalis not only causes tooth loss but also contributes to the development of cardiovascular and cerebrovascular diseases, diabetes and its complications, Alzheimer's disease, and osteoporosis by spreading throughout the body via the bloodstream. The bacteria is mostly ingested through food and is anaerobic in nature. It is commonly found in the gingival sulcus. During the ward rounds, the patient reported toothache, but no abnormalities were found in the department of stomatology. The patient experienced mild toothache for a short duration and did not receive specialist treatment. It is important to note that Porphyromonas gingivalis, a bacterium found in the oral cavity, may cause intracranial infections when it enters the bloodstream and reaches the skull. Clinically, it can be challenging to differentiate between colonized and pathogenic bacteria. Antibacterial drugs cannot completely eradicate microorganisms in the body, but they can alter the body's microecological environment, leading to changes in bacterial composition. Proper specimen collection is crucial for accurate detection of anaerobic bacteria, as exposure to air can contaminate the sample and affect test results. The collection was carried out according to standard operating procedures and the samples were immediately placed into anaerobic culture bottles. During hospitalization, middle-aged patients with good physical condition and no underlying diseases complained of toothache. After consultation with a dental specialist, it was confirmed that there were no oral diseases present. It is important to note that oral colonization of Porphyromonas gingivalis can lead to infection when it enters the bloodstream and reaches the intracranial area. Although the metagene test results showed Porphyromonas gingivalis, it is important to note that meropenem and vancomycin had been used prior to the test, and the possibility of other pathogenic infections cannot be ruled out. It is worth noting that most patients with severe infections have mixed infections, and the two drugs do not cover fungi, although they do cover other pathogens. Identifying the pathogen as soon as possible is crucial for effective clinical treatment. In addition to the results of the gold standard microbial culture, the pathogen can also determine various factors such as the infection site, infection degree, presence of underlying diseases, and affected areas. The patient's DNA-pathogenic microorganism metagenome test was reviewed after discharge, and the results were negative. Therefore, the patient's intracranial infection can be attributed to Porphyromonas gingivalis. (2) The continuous development of medical testing technology has led to the widespread use of metagenomic testing in various fields. Metagenomic testing can identify thousands of bacterial, fungal, viral, and even parasitic species [ 8 ] . It mainly studies the composition of all microbial species and their community functions in environmental samples, and can detect all microbial species and sequence numbers using a specific method [ 9 ] . With its high throughput, fast speed, and comprehensive information, this method offers significant advantages in identifying low-abundance microbial communities and extracting more gene resources. The DNA-pathogenic microorganism metagenomic test was selected for this patient who was negative for multiple CSF bacterial cultures, resulting in a positive diagnosis. While metagenomic testing is widely used, it still has limitations due to the lack of a unified and improved testing process and quality standards [ 10 ] . The test results cannot differentiate between colonized and pathogenic bacteria [ 11 ] . Additionally, antimicrobial susceptibility cannot be determined, and the testing cost is relatively high [ 12 ] . The patient exhibited clear clinical symptoms, and Porphyromonas gingivalis was identified in the laboratory examination. After treatment, both the clinical symptoms and laboratory examination indicators returned to normal, confirming the presence of pathogenic bacteria. The use of metagene detection technology is expected to become increasingly prevalent in clinical practice due to its rapid development. Declarations The patient gave consent for publication. References Xing Yongguo, Meng Wei ying, Zhang Shuxiang, et al. New progress in the diagnosis and treatment of intracranial infection after neurosurgery and craniotomy [J]. Chinese Journal of Hospital Infecology, 2016,26 (22): 5268-5271. Deng Minfeng, Ke Yiquan. New advances in the laboratory diagnosis of bacterial intracranial infections [J]. Chinese Journal of Neuromedicine, 2013,12 (4): 430-432. Li Y, Zhang G, Ma R, et al. The diagnostic value ofcere -brospinal fluids procalcitonin and lactate for thedifferential diagnosis of post-neurosurgical bacterialmeningitis and aseptic meningitis[J]. Clin Biochem, 2015,48(1-2): 50-54. Desai A, Lollis S S, Missios S, et al. How long shouldcerebrospinal fluid cultures be held to detect shuntinfections?[J]. J NeurosurgPediatr, 2009, 4(2): 184-189. Wang Fu, Zhang Xinyuan. Practical anti-infective therapeutics [M]. the second edition. People's Health Press, 2011:613. Van de Beek D, Cabellos C,Dzupova O,et al.ESCMID guidelines:diagnosis and treatment of acute bacterial meningitis[J].Clin Microbiol Infect,2016,22(Suppl 3):S37-S62. Yuta Norimatsu ,Yuki Ohno First report of subcutaneous abscess caused by Porphyromonas gingivalis [J]. ELSVIER. 2020,07(16):1-2. Lecuit M, Eloit M. The diagnosis of infectious diseases by whole genome next generation sequencing: a new era is opening[J]. Front Cell Infect Microbiol, 2014, 4: 25. Grumaz S, Stevens P, Grumaz C, et al. Next⁃generation sequencing diagnostics of bacteremia in septic patients[J]. Genome Med, 2016, 8(1): 73. Guo Lingyun, Li Qinjing, Liu Gang. Current status of metagenomic sequencing technology in the detection of pathogens for central nervous system infections [J]. Chinese Journal of Infectious Diseases, 2019,37 (5): 314-317. hang Jiandong, Han Jingjing, Wang Hongyu. Clinical pharmacists assist in clinical treatment analysis of patients with severe infectious diseases based on metagenomic sequencing technology [J]. Anti-infective pharmacy. 2021,18(07):962-965. Zhu Yimin, Zhang Wenhong. Second-generation sequencing in etiology diagnosis in patients with sepsis [J]. Microorganisms and infection, 2018,13 (7): 97-101. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4230089","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":288376819,"identity":"46241d17-be74-414f-927f-3fe9922a8cf4","order_by":0,"name":"yuqiwang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYBACxmbmgw8+VNjU97M3EKmFub0t2XDGmTTGmT0HiNTC3nPGTJiz7RDjhhsJRGrhnZFgxsxw5gCzwc3HG28w1NhEE9QiOSMh7XFBxR02ydtpxRYMx9JyGwhpMZyRcNx4xplnPHy3c8wkGBsOE9ZifyOxTZq37bAEw80zRGph7DnMBtJiIHCDh1gt7W3MoEBOkOwB+iWBGL8wNvN/BEVlAj/74Y03PtTYENaCDAwkEkhRDtFCqo5RMApGwSgYGQAA2TdHe74Ua3QAAAAASUVORK5CYII=","orcid":"","institution":"Zhejiang provincial People's Hospital Bijie Hospital","correspondingAuthor":true,"prefix":"","firstName":"","middleName":"","lastName":"yuqiwang","suffix":""}],"badges":[],"createdAt":"2024-04-07 07:16:54","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4230089/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4230089/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54514912,"identity":"da6f40e9-ca8b-47b1-bc20-0069acbdb14a","added_by":"auto","created_at":"2024-04-11 16:21:34","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":283570,"visible":true,"origin":"","legend":"\u003cp\u003eDiagram 1: Results of biochemical examination of cerebrospinal fluid\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4230089/v1/c05be51e80efdd323fec0d67.jpeg"},{"id":54514921,"identity":"f5be6eaa-7157-4ebe-9b6c-09a530af77fd","added_by":"auto","created_at":"2024-04-11 16:21:34","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":32760,"visible":true,"origin":"","legend":"\u003cp\u003eDiagram 2: results of routine cerebrospinal fluid examination\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4230089/v1/60970f0683d34df9e06e571f.png"},{"id":54515750,"identity":"8f279228-afa2-473e-abae-07d0d3e2529b","added_by":"auto","created_at":"2024-04-11 16:29:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":229439,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4230089/v1/a39b76a2-acad-4f84-94f0-4c897fcca829.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eA case analysis of intracranial infection of Porphyromonas gingivalis\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIntracranial infections are prevalent in neurology and can lead to increased patient disability and mortality rates if left untreated \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Early diagnosis and treatment is important to improve the prognosis of patients \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Cerebrospinal fluid pathogenesis and associated biomarker testing are decisive in confirming the diagnosis of intracranial infections. The gold standard for cerebrospinal fluid culture is traditional methods, but the positive rate is low \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e and results take a long time to obtain. Typically \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e, it takes 3\u0026ndash;5 days to produce results, which can cause a delay in guiding clinical diagnosis and targeted antibacterial therapy. The field of infection has seen a surge in interest in metagenomic next-generation sequencing due to the continuous development of molecular diagnostic techniques. This technique is particularly useful in detecting rare diseases and special pathogens, and can serve as an important tool for clinical screening of infectious diseases. The most common bacteria causing intracranial infections are Gram-positive cocci, such as Staphylococcus aureus, Enterococcus, MASR, and coagulase-negative Staphylococcus, as well as Acinetobacter baumannii, Enterobacteriaceae, Pseudomonas aeruginosa, Klebsiella pneumoniae, and others \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Patients with rare pathogenic bacterial infections may present negative cerebrospinal fluid (CSF) culture results, which can complicate clinical treatment. This case report presents a patient with intracranial infection caused by Porphyromonas gingivalis, detected through DNA-pathogen microorganism metagenome. This finding provides valuable information for clinical diagnosis and treatment. Display quotations of over 40 words, or as needed.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eThe hospital admitted a 49-year-old female patient on March 5, 2022 due to a persistent headache lasting for over one month and worsening for more than ten days. The patient's symptoms were: scraping-like pain on the left side of the head at first, which lasted for 2\u0026ndash;3 hours to be relieved each time, and then turned to acupuncture-like pain all over the head, and the duration of the pain was longer than before, accompanied by swelling and pain in both eyes and tears. The discomfort was obvious on the left side, with blurred vision, double vision, nausea, and vomiting. The vomitus was stomach contents. He was admitted to the outpatient clinic with \"painful ophthalmoplegia\". After admission, the patient developed headache, accompanied by swelling and pain in both eyes, discomfort with tearing, and his left eye was closed and unable to open. The doctor gave methylprednisolone sodium succinate shock treatment based on the patient's condition and vital signs. On the evening of March 11, the patient's fever persisted, with a body temperature as high as 39.3\u0026deg;C. A clinical pharmacist was invited for consultation. The consultation opinion was that common Gram-positive and negative bacteria in intracranial infections should be considered. According to the \"ESCMID Guidelines: Diagnosis and Treatment of Acute Bacterial Meningitis\" Treatment\"[6], vancomycin hydrochloride combined with ceftriaxone was used for anti-infective treatment. The efficacy of antibacterial drugs is evaluated 48\u0026ndash;72 hours after administration. When the patient's fever and body temperature exceeds 38.5\u0026deg;C, bilateral venous blood samples are taken for bacterial culture and drug sensitivity testing. After the test results are reported, the antibacterial drug treatment plan is adjusted based on the results. On March 13, the patient suffered from intermittent and unbearable pain in his head, and the anti-infective treatment effect was not good. Considering that the patient's condition was serious, ceftriaxone was empirically switched to meropenem for anti-infective treatment. Multiple cerebrospinal fluid cultures and blood cultures were negative, so he was replaced. After taking meropenem, routine and biochemical tests of cerebrospinal fluid were reviewed, which showed that the infection indicators were lower than before, and the symptoms of headache and fever were not significantly relieved. The antibacterial spectrum of meropenem covers anaerobic bacteria, and it is considered that the blood concentration of the drug that may enter the cerebrospinal fluid cannot reach the level. Effective therapeutic concentration. During intracranial infection, lactic acid in cerebrospinal fluid increases significantly, pH decreases, and the increase in protein content reduces the free concentration of antibacterial drugs, affecting the binding of meropenem to proteins, thereby reducing antibacterial activity. The clinical pharmacist recommended that the bedside doctor communicate with the family members and obtain their consent before collecting cerebrospinal fluid samples for DNA-pathogen metagenomic testing. The result suggested: Porphyromonas gingivalis. Based on the patient's clinical symptoms, laboratory test results and anti-infective treatment effects, Porphyromonas gingivalis was determined to be the pathogenic bacteria. The clinical pharmacist consultation recommended that meropenem be discontinued and replaced with metronidazole and sodium chloride injection, and empirical treatment be given. Switch to targeted treatment. Although the patient's clinical symptoms improved after 2 weeks of treatment with metronidazole, they were not completely cleared. The routine and biochemical results of cerebrospinal fluid were still abnormal. After consultation, the clinical pharmacist recommended the addition of vancomycin and meropenem. After 4 weeks of treatment, the patient's clinical symptoms improved. disappear. After discharge, the results of intracranial CT and DNA-pathogen metagenomic testing were negative. The patient was followed up one month later and found no discomfort such as headache, nausea, and vomiting. Figures\u0026nbsp;1 and 2 show the CSF routine and biochemical results during treatment.\u003c/p\u003e \u003cp\u003eDiagram1: Results of biochemical examination of cerebrospinal fluid\u003c/p\u003e \u003cp\u003eDiagram2: results of routine cerebrospinal fluid examination\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e(1) Porphyromonas gingivalis is a non-glycolytic, gram-negative, anaerobic bacterium and an important periodontal pathogen. It commonly colonizes the oral cavity and primarily affects individuals with low immunity or special populations. The relevant domestic and foreign literature was reviewed, and it was found that intracranial infection caused by Porphyromonas gingivalis, excluding oral diseases, is rarely reported both domestically and internationally. This infection is also a significant factor in the development of other diseases such as thrombosis, myocardial infarction, diabetes, endocarditis, coronary heart disease, atherosclerosis, and cerebral infarction \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Porphyromonas gingivalis not only causes tooth loss but also contributes to the development of cardiovascular and cerebrovascular diseases, diabetes and its complications, Alzheimer's disease, and osteoporosis by spreading throughout the body via the bloodstream. The bacteria is mostly ingested through food and is anaerobic in nature. It is commonly found in the gingival sulcus. During the ward rounds, the patient reported toothache, but no abnormalities were found in the department of stomatology. The patient experienced mild toothache for a short duration and did not receive specialist treatment. It is important to note that Porphyromonas gingivalis, a bacterium found in the oral cavity, may cause intracranial infections when it enters the bloodstream and reaches the skull. Clinically, it can be challenging to differentiate between colonized and pathogenic bacteria. Antibacterial drugs cannot completely eradicate microorganisms in the body, but they can alter the body's microecological environment, leading to changes in bacterial composition. Proper specimen collection is crucial for accurate detection of anaerobic bacteria, as exposure to air can contaminate the sample and affect test results. The collection was carried out according to standard operating procedures and the samples were immediately placed into anaerobic culture bottles. During hospitalization, middle-aged patients with good physical condition and no underlying diseases complained of toothache. After consultation with a dental specialist, it was confirmed that there were no oral diseases present. It is important to note that oral colonization of Porphyromonas gingivalis can lead to infection when it enters the bloodstream and reaches the intracranial area. Although the metagene test results showed Porphyromonas gingivalis, it is important to note that meropenem and vancomycin had been used prior to the test, and the possibility of other pathogenic infections cannot be ruled out. It is worth noting that most patients with severe infections have mixed infections, and the two drugs do not cover fungi, although they do cover other pathogens. Identifying the pathogen as soon as possible is crucial for effective clinical treatment. In addition to the results of the gold standard microbial culture, the pathogen can also determine various factors such as the infection site, infection degree, presence of underlying diseases, and affected areas. The patient's DNA-pathogenic microorganism metagenome test was reviewed after discharge, and the results were negative. Therefore, the patient's intracranial infection can be attributed to Porphyromonas gingivalis.\u003c/p\u003e \u003cp\u003e(2) The continuous development of medical testing technology has led to the widespread use of metagenomic testing in various fields. Metagenomic testing can identify thousands of bacterial, fungal, viral, and even parasitic species \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. It mainly studies the composition of all microbial species and their community functions in environmental samples, and can detect all microbial species and sequence numbers using a specific method \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. With its high throughput, fast speed, and comprehensive information, this method offers significant advantages in identifying low-abundance microbial communities and extracting more gene resources. The DNA-pathogenic microorganism metagenomic test was selected for this patient who was negative for multiple CSF bacterial cultures, resulting in a positive diagnosis. While metagenomic testing is widely used, it still has limitations due to the lack of a unified and improved testing process and quality standards \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. The test results cannot differentiate between colonized and pathogenic bacteria \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Additionally, antimicrobial susceptibility cannot be determined, and the testing cost is relatively high \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. The patient exhibited clear clinical symptoms, and Porphyromonas gingivalis was identified in the laboratory examination. After treatment, both the clinical symptoms and laboratory examination indicators returned to normal, confirming the presence of pathogenic bacteria. The use of metagene detection technology is expected to become increasingly prevalent in clinical practice due to its rapid development.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp \u003eThe patient gave consent for publication.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eXing Yongguo, Meng Wei ying, Zhang Shuxiang, et al. New progress in the diagnosis and treatment of intracranial infection after neurosurgery and craniotomy [J]. Chinese Journal of Hospital Infecology, 2016,26 (22): 5268-5271.\u003c/li\u003e\n\u003cli\u003eDeng Minfeng, Ke Yiquan. New advances in the laboratory diagnosis of bacterial intracranial infections [J]. Chinese Journal of Neuromedicine, 2013,12 (4): 430-432.\u003c/li\u003e\n\u003cli\u003eLi Y, Zhang G, Ma R, et al. The diagnostic value ofcere -brospinal fluids procalcitonin and lactate for thedifferential diagnosis of post-neurosurgical bacterialmeningitis and aseptic meningitis[J]. Clin Biochem, 2015,48(1-2): 50-54.\u003c/li\u003e\n\u003cli\u003eDesai A, Lollis S S, Missios S, et al. How long shouldcerebrospinal fluid cultures be held to detect shuntinfections?[J]. J NeurosurgPediatr, 2009, 4(2): 184-189.\u003c/li\u003e\n\u003cli\u003eWang Fu, Zhang Xinyuan. Practical anti-infective therapeutics [M]. the second edition. People\u0026apos;s Health Press, 2011:613.\u003c/li\u003e\n\u003cli\u003eVan de Beek D, Cabellos C,Dzupova O,et al.ESCMID guidelines:diagnosis and treatment of acute bacterial meningitis[J].Clin Microbiol Infect,2016,22(Suppl 3):S37-S62.\u003c/li\u003e\n\u003cli\u003eYuta Norimatsu ,Yuki Ohno First report of subcutaneous abscess caused by Porphyromonas gingivalis [J]. ELSVIER. 2020,07(16):1-2.\u003c/li\u003e\n\u003cli\u003eLecuit M, Eloit M. The diagnosis of infectious diseases by whole genome next generation sequencing: a new era is opening[J]. Front Cell Infect Microbiol, 2014, 4: 25.\u003c/li\u003e\n\u003cli\u003eGrumaz S, Stevens P, Grumaz C, et al. Next⁃generation sequencing diagnostics of bacteremia in septic patients[J]. Genome Med, 2016, 8(1): 73.\u003c/li\u003e\n\u003cli\u003eGuo Lingyun, Li Qinjing, Liu Gang. Current status of metagenomic sequencing technology in the detection of pathogens for central nervous system infections [J]. Chinese Journal of Infectious Diseases, 2019,37 (5): 314-317.\u003c/li\u003e\n\u003cli\u003ehang Jiandong, Han Jingjing, Wang Hongyu. Clinical pharmacists assist in clinical treatment analysis of patients with severe infectious diseases based on metagenomic sequencing technology [J]. Anti-infective pharmacy. 2021,18(07):962-965.\u003c/li\u003e\n\u003cli\u003eZhu Yimin, Zhang Wenhong. Second-generation sequencing in etiology diagnosis in patients with sepsis [J]. Microorganisms and infection, 2018,13 (7): 97-101. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Zunyi Medical University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"porphyromonas gingivalis, pharmaceutical care, metagenomic sequencing","lastPublishedDoi":"10.21203/rs.3.rs-4230089/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4230089/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eOBJECTIVE A case of intracranial infection caused by Porphyromonas gingivalis was analyzed to provide evidence for clinical treatment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMETHODS In one patient with intracranial infection, the results of multiple blood culture and cerebrospinal fluid culture were negative, and no pathogenic bacteria were found. Porphyromonas gingivalis in cerebrospinal fluid was determined by macrogene detection method, and the empirical selection of vancomycin combined with ceftriaxone anti-infection treatment was converted to metronidazole target treatment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRESULTS After 4 weeks of treatment, the patients recovered completely, and the laboratory examination indexes were normal. The results of brain CT and cerebrospinal fluid metagene test were negative.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCONCLUSION For intracranial infection caused by rare microorganisms, under the premise of negative results of classical bacterial culture, advanced macrogene sequencing method can be used to determine pathogens, providing rapid and accurate detection results for clinical treatment.\u003c/p\u003e\n\u003cp\u003eSubject classification codes: include these here if the journal requires them\u003c/p\u003e","manuscriptTitle":"A case analysis of intracranial infection of Porphyromonas gingivalis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-11 16:21:29","doi":"10.21203/rs.3.rs-4230089/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9c6923ca-2d33-4223-ae19-e99081f57a9e","owner":[],"postedDate":"April 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":30360382,"name":"Infectious Diseases"}],"tags":[],"updatedAt":"2024-04-11T16:21:29+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-11 16:21:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4230089","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4230089","identity":"rs-4230089","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}