PMC8631361_01
The treatment procedures and corresponding leukocyte counts in the patient's cerebrospinal fluid. Monocytes were predominant among CSF white cells; they had a proportion of approximately between 60 and 90%. The CSF protein level was also elevated to 95.00-125.20 mg/dl. mNGS.P, metagenomic next-generation sequencing of cerebrospinal fluid detected Sarocladium strictum positive; Culture.P, Sarocladium strictum was positive in cerebrospinal fluid culture.
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F1
The WBC count in her CSF also reduced gradually (Figure 1).
(A) The fungal hyphae by Gram stain (x100). (B) The colony on Sabouraud's agar plates after 2d at 28 C. (C) Micromorphology of a colony of Sarocladium strictum (lactophenol cotton blue preparation, x100).
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F2
FX (PEDS plus) was used for both blood and CSF cultures, but only CSF was positive on the third day (3d2h58m) of incubation. Floccus grew in a positive culture bottle of CSF, and fungal hyphae could be visualized on Gram staining (Figure 2A). White tufted colonies with a pale salmon pink-colored base were observed (Figure 2B). Lactophenol cotton blue preparations from the colonies revealed abundant, small, cylindrical conidia that were produced from the phialide tips of long, slender, lateral hyphae (Figure 2C).
The coverage and abundance of Sarocladium strictum detected by mNGS on March 19, 2021.
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F3
Figure 3. Furthermore, detected reads are shown in Supplement File 1.