Coinfection of and in the human central nervous system: A case report.

Background: () is an anthropozoonotic pathogen that shows clinical manifestations of meningitis, septicemia, and arthritis in infected humans. is another type of anthropozoonotic bacteria, with clinical manifestations of skin, lung, and brain abscesses in infected humans. Few intracranial infections caused by or have been reported. To the best of our knowledge, no study has reported a patient with simultaneous intracranial infection by and .

Case Summary: A 66-year-old male presented at Liaocheng People's Hospital (Liaocheng, Shandong Province, China) reporting dizziness with nausea and vomiting. Metagenomic next-generation sequencing (mNGS) was performed on cerebrospinal fluid for examination, and the patient was diagnosed with suppurative meningitis caused by infection. He received anti-infection treatment with penicillin sodium and ceftriaxone. The patient's condition initially improved but then deteriorated. Further mNGS of cerebrospinal fluid revealed both and . Imaging examination revealed a brain abscess. Furthermore, a mixed infection of and was detected in the patient's central nervous system. The patient was treated with antibiotics and sulfamethoxazole. He was discharged after his condition improved.

Conclusion: This case shows that the disease can be recurrent in patients with intracranial infection of a rare pathogen. The possibility of mixed infection should also be considered, especially in patients treated with immunosuppressive agents. mNGS of cerebrospinal fluid is a supplement to conventional microbial pathogen identification methods. Patients with unknown pathogen diagnosis, early extensive use of antibiotics and infection with rare pathogens can be diagnosed by the combination of conventional methods and mNGS of cerebrospinal fluid.