PMC6727102_01
Gram staining of the cerebrospinal fluid sample showing short gram-negative rods captured by a neutrophil.
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Based on Gram staining of the CSF sample (Fig. 1), we diagnosed bacterial meningitis.
Phylogenetic relationship of K. variicola JMUB4039 with other Klebsiella species.. The maximum parsimony tree was constructed using the majority of single nucleotide polymorphisms present in at least 75% of genomes analyzed by kSNP3.0 program (ref. S.N. Gardner et al., 2015 Bioinformatics Vol. 31 2877-2878). The 39 genome sequences analyzed were obtained from seven Klebsiella species.
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We also determined the whole genome sequence of the strain detected from the blood sample (JMUB4806), and the sequence was compared with 37 genome sequences, including those of 13 known K. variicola strains (Fig. 2).
Head magnetic resonance imaging three days after the third surgery showing severe inflammation in the bilateral frontal lobes and fluid collection in the third ventricle (white arrow).. a. T1, T1-weighted image; b. T2, T2-weighted image; c. FLAIR, fluid-attenuated inversion recovery; d. DWI, diffusion-weighted image.
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Head magnetic resonance imaging (MRI) three days after the third surgery showed severe inflammation in the bilateral frontal lobes and fluid collection in the third ventricle (Fig. 3).
Head magnetic resonance imaging 30 days after the third surgery showing diminished inflammation in the bilateral frontal lobes and disappearance of fluid collection in the third ventricle.. a. T1, T1-weighted image; b. T2, T2-weighted image; c. FLAIR, fluid-attenuated inversion recovery; d. DWI, diffusion-weighted image.
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Thirty days after the third surgery, head MRI (Fig. 4) was performed; although hydrocephalus had worsened, the inflammation in the bilateral frontal lobes had diminished, and fluid collection in the third ventricle had disappeared.