Pediatric pyopneumothorax caused by Prevotella oris successfully diagnosed via mNGS: a case report and literature review
Abstract
Background: Empyema and pyopneumothorax are severe complications of pediatric community-acquired pneumonia. While typically caused by aerobic bacteria, anaerobic infections, particularly those involving Prevotella oris (P. oris), are exceedingly rare in children. This study aims to explore the clinical characteristics, diagnostic challenges, and therapeutic strategies for pediatric pyopneumothorax caused by P. oris, thereby enhancing clinical awareness of this uncommon opportunistic pathogen.
Case presentation: We retrospectively analyzed the clinical data of a 10-year-old male admitted to the Hebei Children's Hospital in October 2025, presenting with acute chest pain and a history of tooth extraction 1 week prior to symptom onset. Radiological imaging revealed bilateral pneumonia with bilateral pleural effusions (predominantly on the left side). Pleural fluid analysis was consistent with an empyema. Traditional bacterial cultures of blood and pleural fluid yielded negative results. However, probe-based targeted metagenomic next-generation sequencing (mNGS) of the pleural fluid identified P. oris with a high relative abundance (81.86%), alongside other minor oral commensals. Based on the molecular diagnosis and the patient's ongoing clinical deterioration, cefoperazone-sulbactam was selected to strengthen coverage against anaerobic Gram-negative organisms, while linezolid was temporarily added to cover potential Gram-positive pleural co-infection during the acute…
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