title: Detection of Staphylococcus aureus by 16S rRNA directed in situ hybridisation in a patient with a brain abscess caused by small colony variants.
abstract: A 45 year old man was admitted to hospital with a right sided facial paralysis and three month history of seizures. Computed tomography showed a left temporal mass including both intracerebral and extracerebral structures. Ten years earlier the patient had undergone a neurosurgical intervention in the same anatomical region to treat a subarachnoid haemorrhage. In tissue samples and pus obtained during neurosurgery, Staphylococcus aureus was detected by a 16S rRNA-directed in situ hybridisation technique. Following long term cultivation, small colony variants (SCV) of methicillin resistant S aureus were identified. The patient was treated successfully with a combination of vancomycin and rifampin followed by prolonged treatment with teicoplanin, with no sign of infection on follow up nine months after discharge. This is the first report in which S aureus SCV have been identified as causative organisms in a patient with brain abscess and in which in situ hybridisation has been used to detect S aureus in a clinical specimen containing SCV. Antimicrobial agents such as rifampin which have intracellular activity should be included in treatment of infections caused by S aureus SCV.
authors.affiliation: Institute of Medical Microbiology, Hospital and Clinics, University of Münster, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Kipp
authors.forename: W
authors.initials: W
authors.lastname: Ziebuhr
authors.forename: K
authors.initials: K
authors.lastname: Becker
authors.forename: V
authors.initials: V
authors.lastname: Krimmer
authors.forename: N
authors.initials: N
authors.lastname: Höbeta
authors.forename: G
authors.initials: G
authors.lastname: Peters
authors.forename: C
authors.initials: C
authors.lastname: Von Eiff
mesh_terms: D001922:Brain Abscess / Q000382:microbiology* / Q000473:pathology; D006801:Humans; D017403:In Situ Hybridization; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D012336:RNA, Ribosomal, 16S / Q000032:analysis / Q000235:genetics*; D013203:Staphylococcal Infections / Q000150:complications*; D013211:Staphylococcus aureus / Q000235:genetics* / Q000302:isolation & purification / Q000472:pathogenicity
chemical_list: D012336:RNA, Ribosomal, 16S