Combination of next-generation sequencing and traditional examinations for identifying Leuconostoc garlicum: A case report.

Abstract

Background: Leuconostoc garlicum is commonly found in fermented foods and very few infected patients have been reported, who typically present symptoms such as fever and fatigue. Conventional clinical examinations often struggle to identify this bacterium, and routine anti-infective treatments are generally ineffective. Both diagnostic challenges and therapeutic limitations pose significant difficulties for clinicians.

Case summary: We report a patient ultimately diagnosed with Leuconostoc garlicum infection. The primary manifestations included persistent fever, cough and fatigue. These symptoms lasted for 2 months. He received anti-infective treatment at a community hospital, but this was ineffective. After inquiring about the patient's medical history and conducting a physical examination, the patient underwent laboratory tests. Complete blood count tests revealed that the patient had a high proportion of neutrophils, C-reactive protein level was 235.9 mg/L, erythrocyte sedimentation rate was 67 mm/h, respiratory pathogen testing was negative, and he was then thought to have an infectious disease. However, conventional anti-infective treatments were ineffective. After excluding infectious neurological diseases, urologic diseases and digestive problems, we ultimately focused our attention on the lungs. A lung computed tomography scan indicated pulmonary inflammation. Bronchoalveolar lavage fluid for next-generation sequencing suggested lung infection with Leuconostoc garlicum. The patient's symptoms gradually improved following treatment with piperacillin tazobactam and linezolid. During the follow-up period, the patient's temperature remained normal.

Conclusion: For patients with suspected bacterial infection and experiencing fever, conventional anti-infective treatment can be ineffective in controlling their symptoms, and an infection due to rare bacteria or drug-resistant bacteria should be considered. Next-generation sequencing enables rapid and precise identification of infection-related pathogens in febrile patients.