Intracranial abscess due to Prevotella bivia: first case report in India (2023)

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history and exam

A 50-year-old man, known to have been diabetic for 5 years, with irregular intake of oral hypoglycemic agents, presented to our tertiary hospital in southern India, complaining of sudden onset of weakness in the right upper and lower limbs for 3 days. Simultaneously, he developed a deviated angle of the mouth and difficulty speaking, associated with neck pain and worsening headache. He had a single episode of generalized tonic-clonic seizure 3 days prior to admission.


Brain abscess is a focal pyogenic infection of the brain parenchyma. The incidence of brain abscesses is increasing due to their frequent association with immunocompromised conditions [2]. Brain abscesses are polymicrobial and the etiology often depends on the mode of acquisition. The most commonly isolated organisms are anaerobic bacteria, aerobic and microaerophilic streptococci, members of the Enterobacteriaceae family, and Staphylococcus aureus [8]. Timely identification of the causative agent,


A rare case of brain abscess in an elderly diabetic man due to P. bivia is presented. It is the first isolation in India and the third in the world. Surgical drainage followed by immediate pathogen identification and antibiotic therapy guided by antimicrobial susceptibility resulted in a successful outcome in our patient.

Declaration of competing interest

There is no conflict of interest.

  • Prevotella: An insight into its characteristics and associated virulence factors

    2022, Microbial Pathogenesis

    Quote Excerpt:

    Its greater abundance in the gut has been associated with a diet containing higher carbohydrate and fiber content, as demonstrated by several authors, suggesting it as a beneficial gut bacterium [15-17]. Despite being a commensal bacterium, Prevotella spp. along with other microbes of the normal microflora it is implicated in causing various localized infections of the ear and nasal cavity such as chronic otitis media and chronic sinusitis [18,19]; neck infections such as cervical abscess [20], retropharyngeal space infection, and peritonsillar abscess [21–23]; dental diseases such as periodontitis [24-28] and dental caries [29,30]; lung infections such as lung abscess and pneumonia [31-33]; gastrointestinal infections such as peritonitis [34-36], intra-abdominal abscess [37-39], ulcerative colitis [40,41]; other infections such as brain abscess [42-44], endocarditis [45], arthritis [46-49], osteomyelitis [50-52], carotid atherosclerosis [45,53], skin and soft tissue infections [54,55] and bacterial vaginosis [56]. In the list of diseases, Prevotella spp. are strongly associated with periodontitis [27,28,57,58].

    Prevotella species, an obligate gram-negative anaerobe, is commonly associated with human infections such as dental caries and periodontitis, as well as other conditions such as chronic osteomyelitis, bite-related infections, rheumatoid arthritis, and intestinal diseases such as ulcerative colitis. This generally harmless commensal possesses virulence factors such as adhesins, hemolysins, exopolysaccharide secretion systems, LPS, proteases, quorum-sensing molecules, and antibiotic resistance to evolve into a well-adapted pathogen capable of causing successful infection and proliferation in host tissue. . This review describes several of these virulence factors and their advantage for Prevotella spp. to cause inflammatory diseases such as periodontitis. Furthermore, using genome analysis of Prevotella reference strains, we examine other putative virulence determinants that may provide information as biomarkers and be targets for effective interventions in Prevotella-related diseases such as periodontitis.

  • Subcutaneous abscess in the shoulder caused by Prevotella bivia infection

    2022, anaerobes

    Quote Excerpt:

    It is occasionally isolated from the intraoral space. As its infection to other parts of the body is extremely rare, only a few cases of paronychia, chest abscess and other infections due to this species have been previously reported [2-5]. Here, we report a case of subcutaneous abscess due to P. bivia that repeatedly developed on the right shoulder of a middle woman.

    Prevotella bivia (P.bivia) is an anaerobic Gram-negative rod that usually lives in the urogenital system, and sometimes in the intraoral space, whose infection to other parts of the body is extremely rare. In this report, we describe a rare case of recurrent infectious P.bivia abscess on the right shoulder of a middle-aged woman.

  • Scrotal abscess in a Japanese patient caused by prevotella bivia and streptococcus agalactiae, successfully treated with cefazolin and amoxicillin: case report

    2021, International Journal of Medical Case Reports

  • Research Article

    Thanks to reviewers

    Anaerobic, Volume 67, 2021, Article 102330

  • Research Article

    Highbush bilberry proanthocyanidins alleviate deleterious effects induced by Porphyromonas gingivalis on oral mucosal cells

    Anaerobic, Volume 65, 2020, Article 102266

    Strong evidence points to Porphyromonas gingivalis, a Gram-negative anaerobic bacterium, as a key species in the development of the chronic form of periodontitis. The aim of the present study was to investigate the ability of highbush blueberry proanthocyanidins (PACs) to alleviate the deleterious effects induced by P.gingivalis on oral mucosal cells. First, we show that highbush bilberry PACs protect the integrity of the gingival keratinocyte barrier against P. gingivalis-mediated damage, as determined by measuring transepithelial electrical resistance and paracellular flux of FITC-conjugated dextran. Furthermore, PACs prevented the translocation of P.gingivalis through the gingival keratinocyte barrier model. Proteinase activity of P.gingivalis was inhibited by PACs suggesting that they may exert beneficial effects by reducing proteolytic degradation of tight epithelial junctions. The regulation of inflammatory reactions of gingival fibroblasts may be one of the ways to prevent and control the progression and severity of periodontal disease. We showed that PACs significantly reduce IL-6 and IL-8 secretion by P. gingivalis-stimulated gingival fibroblasts. The present study showed the ability of highbush bilberry PACs to protect the integrity of an in vitro barrier model of gingival keratinocytes against P. gingivalis, and to attenuate the secretion of pro-inflammatory cytokines by gingival fibroblasts infected with P. gingivalis. These results suggest beneficial effects of blueberry PACs, thus supporting the need for future clinical trials on the potential of these bioactive molecules for prevention and/or treatment of periodontal diseases.

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    Disseminated mycobacterium avium intracellulare leading to protein-losing enteropathy in an elderly man with idiopathic CD4 lymphocytopenia

    Annals of Allergy, Asthma & Immunology, Volume 119, Issue 4, 2017, pp. 390-391.e1

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    Percutaneous endoscopic gastrojejunostomy in pediatric intestinal pseudo-obstruction

    Nutrition, Volume 86, 2021, Article 111174

    Pediatric intestinal pseudo-obstruction (PIPO) is the "tip of the iceberg" of the most serious intestinal motility disorders. In patients with POP, the impairment of gastrointestinal propulsion patterns is such that it results in progressive obstructive symptoms with no evidence of mechanical causes. PIPO is an important cause of intestinal failure and affects pubertal growth and development. Intestinal loop and abdominal distension represent one of the main characteristics of intestinal pseudo-obstruction syndromes, therefore, intestinal decompression is one of the pillars of the management of POP. Until now, pharmacological, endoscopic, and surgical treatments have failed to achieve long-term relief of intestinal distention and related symptoms, including pain. Recent data, however, have indicated that percutaneous endoscopic gastrojejunostomy (PEG-J) may be a minimally invasive approach for bowel decompression, thereby improving abdominal symptoms and nutritional status in adult patients with chronic intestinal pseudo-obstruction. Based on these promising results, we treated for the first time a 12-year-old patient with PIPO refractory to any therapeutic option to achieve intestinal decompression by PEG-J. We showed that PEG-J produced sustained small bowel decompression in the reported PIPO patient, with considerable improvement in abdominal symptoms and nutritional status. The positive result of the present case provides a basis for testing the actual effectiveness of PEG-J versus other therapeutic approaches for bowel decompression in patients with POP.

  • Research Article

    Phenotypic and genotypic profiles of antimicrobial resistance of faecal lactobacilli from domesticated pigeons in Poland

    Anaerobic, Volume 65, 2020, Article 102251

    Lactobacillus species play an important role in the host and, although they are not pathogenic, they can act as reservoirs of antibiotic resistance genes, with a potential risk of transfer to other bacteria that inhabit the gastrointestinal tract. The aim of this study was to identify Lactobacillus species derived from feces of domesticated pigeons and to characterize their phenotypic and genotypic antimicrobial resistance (AMR) profiles. A total of 57 Lactobacillus isolates were classified into six species using the MALDI-TOF technique and 16S rDNA restriction analysis. Strains of L. ingluviei (31%), L.salivarius (28%) and L.agilis (23%) were the dominant species isolated. Determination of antimicrobial susceptibility by the broth microdilution method showed widespread resistance to kanamycin (89%), tetracycline (84%), streptomycin (63%) and enrofloxacin (37%). Less than 30% of the isolates were resistant to erythromycin, lincosamides, gentamicin, chloramphenicol and vancomycin. More than half (51%) of lactobacilli were classified as multiresistant. Tet genes were detected in 79% of the isolates; lnuA, cat, ermB, ermC, ant(6)-Ia, ant(4')-Ia and int-Tn genes were found less frequently. Sequence analysis of the quinolone resistance determining region (QRDR) of the gyrA gene showed that fluoroquinolone resistance in lactobacilli was the result of a mutation that led to a change in the amino acid sequence (Ser83→Tyr/Leu/Phe). Domesticated pigeons can be a reservoir for Lactobacillus AMR strains and AMR genes.

  • Research Article

    Healing activity of the hydroalcoholic extract and the main metabolites of Amphipterygium adstringens (cuachalalate) in an excision model in rats

    Journal of Ethnopharmacology, Volume 293, 2022, Artigo 115313

    The bark of Amphipterygium adstringens Schiede ex Schltdl (Anacardiaceae), commonly known as 'cuachalalate', has been used in traditional Mexican medicine for the treatment of cutaneous and oral lesions, gastric ulcers and other conditions. The use of the bark of this plant as a healing agent has been known since before the Spanish conquest of Mexico. Its uses are mentioned in the first writings of the Spaniards in the 16th century. It is important to emphasize that its use for wound healing treatment has no previous scientific reports.

    The objectives of this study were to determine the healing effect of the hydroalcoholic extract of the stem bark of Amphipterygium adstringens and its main metabolites, using an excision model on the back of Wistar rats. Evaluate its antimicrobial effect against common bacteria that live on the skin of wounds and evaluate its effect on angiogenesis.

    Cuachalalate hydroalcoholic extract (HAE, 10 mg/wound/day), 3α-hydroxymasticadienoic acid (3MA, 300 μg/wound/day), masticadienoic acid (MA, 300 μg/wound/day) and a mixture of acids anacardiacs (ANA, 300μg per wound) were tested in a murine excision model topically for 15 days, to evaluate their wound healing effect. Results were reported in percent wound closure (n=30 animals per treatment curve), using pirfenidone (PIR, 8% in vehicle) as the reference drug. In addition, histological analysis was performed to assess the structure and quality of the scar. The effect on angiogenesis was assessed using the chicken embryo chorioallantoic membrane (CAM) model (n = 6 eggs per treatment). The concentration evaluated for each treatment was 300μg, using histamine (HIS, 5.6μg) as reference proangiogenic drug and pirfenidone (9μg) and acetylsalicylic acid (ASA, 9μg) as antiangiogenic drugs. Antimicrobial testing was performed against S. mutans, S. aureus, P. aeruginosa and E. coli using a minimum inhibitory concentration (MIC) assay.

    3α-Hydroxymasticadienoic acid (3MA) and anacardic acids (ANA) improve wound closure by approximately 30% (similar to pirfenidone) compared to vehicle-treated control in the proliferative phase. On the other hand, the hydroalcoholic extract of cuachalalate (HAE) showed no effect on the wound healing process. Histological analysis showed that the three main metabolites showed improvement in the scar structure. According to the CAM results, it is likely that the main mechanism of action of 3α-hydroxymasticadienoic acid and anacardic acids is related to their pro-angiogenic effect. Furthermore, ANA showed a modest antimicrobial effect.

    3α-hydroxymasticadienoic acid and anacardic acids showed better tissue structure and reduced wound closure time. Furthermore, anacardic acids showed antimicrobial effects and both metabolites promote angiogenesis, suggesting that these effects may be related to their mechanism of action. These cuachalalate metabolites may be a good alternative for wound healing treatment.

© 2020 Elsevier Ltd. All rights reserved.


What is the cause of prevotella bivia? ›

Prevotella bivia is an anaerobic, gram-negative bacillus which naturally thrives in the human vagina, and is usually related to vaginal tract infections. However, this microorganism can also cause infections in other body locations.

What bacteria is most common in brain abscess? ›

The most frequent microbial pathogens isolated from brain abscesses are Staphylococcus and Streptococcus. Among this class of bacteria, Staphylococcus aureus and Viridian streptococci are the commonest.

How do you treat Prevotella bivia infection? ›

Clindamycin is a highly effective antibiotic against Prevotella spp., Porphyromonas, and Fusobacterium.

What is the most common cause of brain abscess? ›

In some cases, a brain abscess develops from an infection in the sinuses. The source of the infection is often not found. However, the most common identified source is a lung infection. Less often, a heart infection is the cause.

Where does Prevotella bacteria come from? ›

Prevotella species, related to colonic Bacteroides, are the largest single bacterial group reported from the rumen of cattle and sheep under most dietary regimes. These organisms are highly diverse, and the single species P. ruminicola has been reclassified into four new species, P. ruminicola, P.

What are the symptoms of prevotella bivia? ›

Common symptoms include diarrhea, tenesmus, and dull pelvic pain. 1 Typical pathogens include Neisseria gonorrhea, Chlamydia trachomatis, Treponema pallidum, and herpes simplex.

What are the 2 types of brain abscess? ›

Intracranial abscesses are uncommon, serious, life-threatening infections. They include brain abscess and subdural or extradural empyema and are classified according to the anatomical location or the etiologic agent. The term brain abscess is used in this article to represent all types of intracranial abscesses.

How long does it take for a brain abscess to develop? ›

A brain abscess can grow very quickly, typically becoming fully formed within about two weeks. Your doctor will begin treatment immediately after you are diagnosed. Prompt medical attention is the key to relieving your symptoms more quickly and minimizing damage to your long-term health.

What is the rare cause of brain abscess? ›

Cerebral phaeohyphomycosis (CP) is a very rare but serious form of central nervous system fungal infection that is caused by dematiaceous fungi. It is commonly associated with poor prognosis irrespective of the immune status of the patient.

Is prevotella bivia rare? ›

Prevotella bivia is a rare cause of infection in the literature, with only 18 documented cases of infection globally, and the optimal antibiotic regimen reported from those cases varies widely [7].

What covers prevotella bivia? ›

bivia strains are β-lactamase positive. Several studies have suggested that clindamycin, amoxicillin/clavulanate, metronidazole, and imipenem are all effective against P. bivia [1, 5].

How is Prevotella transmitted? ›

Prevotella spp. may cause lung, abdomen or brain abscesses. Furthermore, the bacteria can elicit dental, lower abdomen and wound infections. Transmission occurs via direct or indirect contact with infected persons.

Can you fully recover from brain abscess? ›

If left untreated, a brain abscess can cause permanent brain damage and could be fatal. A brain abscess is usually treated using a combination of: medicines – either antibiotics or antifungals.

Can brain abscess heal without surgery? ›

Your healthcare provider can treat cerebral abscesses with medicines, including antibiotics or drugs to fight a fungal infection. Your healthcare provider may also give you steroid drugs to lower pressure in your brain, or other drugs to reduce seizures. You may need surgery, especially for larger abscesses.

How can brain abscess be prevented? ›

You can reduce the risk of developing a brain abscess by getting treated for infections or health problems that can cause them. Some people, including those with certain heart disorders, may receive antibiotics before dental or other procedures to help reduce the risk of infection.

What foods increase Prevotella? ›

Prevotella is associated with plant-rich diets (high levels of complex carbohydrates and fruit and vegetable intake), whereas Bacteroides is linked to a high intake of fat and protein. Bacteroides and Prevotella species have their own specific habitats in the human body as they are antagonistic.

What is the treatment of choice for Prevotella? ›

The oral drug of choice is amoxicillin clavulanate.

What infections are caused by Prevotella? ›

Prevotella species are commonly associated with periodontal and oral infections; however, they are also rare causes for skin and soft tissue infections [2]. Prevotella are related to the Bacteroides genus and are part of a group of anaerobic Gram-negative bacilli that are commonly implicated in human infections [2,3].

What antibiotic treats Prevotella? ›

Related Topics
  • Metronidazole.
  • Metronidazole.
  • Piperacillin.
  • Secnidazole.
  • Amoxicillin + Clavulanate.
  • Dental Infections.
  • Ticarcillin.
  • Brain Abscess.
Oct 10, 2021

Can a man get prevotella bivia? ›

P. bivia infection has been reported to cause penile abscesses in concomitant infection with Streptococcus constellatus, in which case treatment involved surgical drainage and antibiotic treatment initially with IV vancomycin and clindamycin, and then oral amoxicillin/clavulanate [41].

Where do you get Prevotella? ›

Interestingly, bacterial Prevotella species have been found to be prevalent commensal colonizers at mucosal sites; being the predominant genus in the respiratory system4, 5 and a central constituent in one of three gut bacterial enterotypes,6 as well as present in saliva and several oral sites.

How long is recovery from brain abscess? ›

Most people need a further 6 to 12 weeks rest at home before they're fit enough to return to work or full-time education. After treatment for a brain abscess, avoid any contact sport where there's a risk of injury to the skull, such as boxing, rugby or football.

What are the 4 stages of brain abscess? ›

Brain abscess passes through 4 stages: early cerebritis, late cerebritis, early capsule, and late capsule. During early cerebritis, nonenhanced CT scans may demonstrate normal findings or may show only poorly marginated subcortical hypodense areas.

How long is the treatment for a brain abscess? ›

The duration of intravenous antimicrobial therapy in patients with bacterial brain abscess has traditionally been 6 to 8 weeks. Prolonged treatment with metronidazole has been associated with neuropathy.

What are the long term effects of a brain abscess? ›

A brain abscess can lead to long-term neurological problems, involving issues with physical function, personality changes, and seizures.

Does brain abscess show on MRI? ›

For example, in the late stage of bacterial infection, the formation of brain abscess shows MRI manifestation as a typical rim-like enhancement, which is often similar to necrotic malignant tumors, especially glioblastoma multiforme (GBM) (8).

Can a CT scan detect a brain abscess? ›

CT scan gives fare idea about size of brain abscess. So we know the amount of pus that should be drained.

Where is brain abscess most common? ›

Abscess occurs most commonly in the frontal lobe but may occur in any location. Location is closely associated with source. Otogenic abscess occurs almost exclusively in the temporal lobe and cerebellum, while abscess associated with sinus infection is predominantly frontal.

What percentage of people get brain abscess? ›

It accounts for less than 1% of intracranial lesions in the developed world, as opposed to roughly 8% in developing countries. Without access to advancements in diagnostic imaging and antibiotic regimens, the development of brain abscess from otogenic and odontogenic infections continues unabated.

What is the most common route of spread of infection to the brain? ›

The most common route of transmission is through hematogenous spread. Others gain access to the CNS via direct spread from local infectious foci, after head trauma or neurosurgery, or during vaginal delivery from untreated GBS-colonized mothers.

Is Prevotella good or bad? ›

Our scientists have found 15 “good” gut microbes that are associated with indicators of good health and 15 “bad” gut microbes that are linked with worse health. Prevotella copri — or “Patrick” as we call him — is one of the 15 “good” bugs.

What is the rarest bacteria in the world? ›

Deinococcus radiodurans
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What does high Prevotella mean? ›

High levels of Prevotella copri and similar species are correlated with low levels of microbiota previously associated with immune regulating properties. In addition, some nutrients can alter intestinal permeability and thereby influence the immune response without a known impact on the microbiota.

What is the prevalence of Prevotella? ›

Several Prevotella species inhabit the human gut, among which Prevotella copri is the most common with estimates indicating ~ 40% prevalence in the wider human population and relative abundances that exceed 50% in some individuals1.

Can prevotella bivia cause infertility? ›

Prevotella was increased in the seminal fluids of the explained infertility group, along with HPV-positive seminal fluids: an infection commonly associated with infertility, especially male infertility. Prevotella has been described to negatively affect sperm motility.

Does doxycycline cover prevotella bivia? ›

All of the Prevotella strains were susceptible to amoxicillin/clavulanic acid, doxycycline and metronidazole, whereas 7/39 strains were beta-lactamase-positive and resistant to amoxicillin, 5/39 were resistant to clarithromycin and 3/39 were resistant to both moxifloxacin and levofloxacin.

Why is Prevotella important? ›

Prevotella possess a high genetic diversity, representing one of the important groups found in the oral cavity and large intestine of man. The gut commensal Prevotella bacteria contribute to polysaccharide breakdown, being dominant colonisers of agrarian societies.

What is the role of Prevotella in the human gut? ›

Prevotella copri in the human gut are associated with high fibre non-Western diets as they possess extensive repertoires of carbohydrate active enzymes that allow this species to metabolise complex polysaccharides.

Is brain abscess cancerous? ›

The cumulative incidences of cancer among siblings of patients with brain abscess were 10% and 12% among siblings of the comparison cohort. Discussion Brain abscess was associated with substantially increased risk of cancer during the first 10 years after diagnosis.

Can COVID cause a brain abscess? ›

1 There are multiple reports of invasive rhino-orbital–cerebral mucormycosis in a patient with COVID-19. 2 However, the formation of fungal brain abscess following COVID-19 without contiguous sinonasal and orbital diseases is uncommon.

What is the best antibiotics for brain abscess? ›

Treat all brain abscesses with antibiotics (usually initially with ceftriaxone or cefotaxime plus metronidazole if clinicians suspect Bacteroides species or plus vancomycin if they suspect S. aureus), typically followed by CT-guided stereotactic aspiration or surgical drainage.

What happens if abscess is not removed? ›

If a skin abscess is not drained, it may continue to grow and fill with pus until it bursts, which can be painful and can cause the infection to spread or come back.

What is the first line treatment of brain abscess? ›

Antibiotics are the first-line treatment for brain abscess. High-dose, broad-spectrum, intravenous antibiotics should be administered as early as possible in the patient's course. Emergent consultation with neurosurgery is recommended; however, delay in consultation should not delay antibiotic administration.

What are parasitic causes of brain abscess? ›

Protozoa and helminths can also cause parasitic brain abscesses. CNS toxoplasmosis (Toxoplasma gondii), and neurocystcercosis (larval form of Taenia solium) are some of the important examples of parasitic infections.

How do you get more Prevotella bacteria? ›

Diets that are loaded with fruits and veggies and low in meat have been linked to more diverse microbiota and an abundance of good bacteria like Prevotella. Meat-heavy diets can increase the abundance and activity of microorganisms that have been linked to inflammatory bowel disease .

What antibiotics are effective against Prevotella? ›

Prevotella, Porphyromonas, and Other Anaerobic Gram-Negative Rods. Porphyromonas species are generally susceptible to β-lactams, clindamycin, and metronidazole [21].

Is prevotella bivia bad? ›

Prevotella are bacteria that inhabit many parts of the body. Although common in the gut microbiome, if found elsewhere, they may be a sign of trouble or infection. The body is full of damp, dark recesses where bacteria thrive, and this is not a bad thing.

What is the incubation period for Prevotella? ›

Slow grower, some species require > 48 hrs incubation.

Which Indian food has good gut bacteria? ›

Eat fermented foods regularly

Studies have shown that people who consume fermented foods (like yogurt, kimchi, idli, dosa, dhokla, etc.) on a regular basis have a diverse and healthy gut flora, also called gut microbiome. Your gut harbors trillions of friendly bacteria that helps your digestive system work well.

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