{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T16:12:53Z","timestamp":1784823173244,"version":"3.55.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Empyema and pyopneumothorax are severe complications of pediatric community-acquired pneumonia. While typically caused by aerobic bacteria, anaerobic infections, particularly those involving\n                      <jats:italic>Prevotella oris<\/jats:italic>\n                      (\n                      <jats:italic>P. oris<\/jats:italic>\n                      ), are exceedingly rare in children. This study aims to explore the clinical characteristics, diagnostic challenges, and therapeutic strategies for pediatric pyopneumothorax caused by\n                      <jats:italic>P. oris<\/jats:italic>\n                      , thereby enhancing clinical awareness of this uncommon opportunistic pathogen.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed the clinical data of a 10-year-old male admitted to the Hebei Children\u2019s 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\n                      <jats:italic>P. oris<\/jats:italic>\n                      with a high relative abundance (81.86%), alongside other minor oral commensals. Based on the molecular diagnosis and the patient\u2019s 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 deterioration phase. This was combined with closed thoracic drainage and intrapleural urokinase instillation for fibrinolysis, leading to a complete clinical recovery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Prevotella oris<\/jats:italic>\n                      is a rare but significant pathogen in pediatric empyema. A high index of suspicion should be maintained for anaerobic infections in children presenting with a history of dental procedures, abnormal immune parameters or possible immunological vulnerability, or poor response to empirical antibiotics. Traditional cultures are often inadequate; therefore, mNGS serves as a crucial tool for the early detection and precise treatment of difficult-to-culture anaerobes.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1888298","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T15:50:44Z","timestamp":1784821844000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pediatric pyopneumothorax caused by Prevotella oris successfully diagnosed via mNGS: a case report and literature review"],"prefix":"10.3389","volume":"13","author":[{"given":"Zhihui","family":"Yan","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine, Children\u2019s Hospital of Hebei Province","place":["Shijiazhuang, Hebei, China"]},{"name":"Hebei Provincial Clinical Research Center for Child Health and Disease","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaona","family":"Qian","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Children\u2019s Hospital of Hebei Province","place":["Shijiazhuang, Hebei, China"]},{"name":"Hebei Provincial Clinical Research Center for Child Health and Disease","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yixuan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Children\u2019s Hospital of Hebei Province","place":["Shijiazhuang, Hebei, China"]},{"name":"Hebei Provincial Clinical Research Center for Child Health and Disease","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liyuan","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Children\u2019s Hospital of Hebei Province","place":["Shijiazhuang, Hebei, China"]},{"name":"Hebei Provincial Clinical Research Center for Child Health and Disease","place":["Shijiazhuang, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e63103","DOI":"10.1371\/journal.pone.0063103","article-title":"Significance of anaerobes and oral bacteria in community-acquired pneumonia","volume":"8","author":"Yamasaki","year":"2013","journal-title":"PLoS One"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1038\/s41579-021-00559-y","article-title":"Prevotella diversity, niches and interactions with the human host","volume":"19","author":"Tett","year":"2021","journal-title":"Nat Rev Microbiol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"105673","DOI":"10.1016\/j.micpath.2022.105673","article-title":"Prevotella: an insight into its characteristics and associated virulence factors","volume":"169","author":"Sharma","year":"2022","journal-title":"Microb Pathog"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1099\/00207713-40-2-205","article-title":"Prevotella, a new genus to include Bacteroides melaninogenicus and related species formerly classified in the genus Bacteroides","volume":"40","author":"Shah","year":"1990","journal-title":"Int J Syst Bacteriol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1695","DOI":"10.2217\/fmb.10.126","article-title":"New insights into Prevotella diversity and medical microbiology","volume":"5","author":"Alauzet","year":"2010","journal-title":"Future Microbiol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.anaerobe.2011.05.010","article-title":"Burden of emerging anaerobes in the MALDI-TOF and 16S rRNA gene sequencing era","volume":"17","author":"La Scola","year":"2011","journal-title":"Anaerobe"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1146\/annurev-pathmechdis-012418-012751","article-title":"Clinical metagenomic next-generation sequencing for pathogen detection","volume":"14","author":"Gu","year":"2019","journal-title":"Annu Rev Pathol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"S231","DOI":"10.1093\/cid\/ciy693","article-title":"Microbiological diagnostic performance of metagenomic next-generation sequencing when applied to clinical practice","volume":"67","author":"Miao","year":"2018","journal-title":"Clin Infect Dis"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1093\/cid\/cix881","article-title":"Understanding the promises and hurdles of metagenomic next-generation sequencing as a diagnostic tool for infectious diseases","volume":"66","author":"Simner","year":"2018","journal-title":"Clin Infect Dis"},{"key":"ref10","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2013-201554","article-title":"The CARE guidelines: consensus-based clinical case reporting guideline development","author":"Gagnier","year":"2013","journal-title":"BMJ Case Rep"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1007\/s00776-007-1207-1","article-title":"Microbiology and management of joint and bone infections due to anaerobic bacteria","volume":"13","author":"Brook","year":"2008","journal-title":"J Orthop Sci"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1016\/j.resinv.2024.01.012","article-title":"Bacterial profiles detected in ventilator-associated pneumonia in Japan: a systematic review","volume":"62","author":"Moro","year":"2024","journal-title":"Respir Investig"},{"key":"ref13","first-page":"164","article-title":"Lung abscess caused by Prevotella oralis and Prevotella ruminicola in a HIV-positive patient","volume":"20","author":"Marcos S\u00e1nchez","year":"2003","journal-title":"An Med Interna"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.idcr.2017.01.005","article-title":"Prevotella osteomyelitis after dental capping procedure","volume":"8","author":"Williams","year":"2017","journal-title":"IDCases"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"E10","DOI":"10.3171\/2018.10.focus18463","article-title":"Spontaneous spondylodiscitis: review, incidence, management, and clinical outcome in 44 patients","volume":"46","author":"Waheed","year":"2019","journal-title":"Neurosurg Focus"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1186\/s12866-023-03046-x","article-title":"Composition of pathogenic microorganism in chronic osteomyelitis based on metagenomic sequencing and its application value in etiological diagnosis","volume":"23","author":"Zhang","year":"2023","journal-title":"BMC Microbiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.anaerobe.2018.05.005","article-title":"A multicenter survey of antimicrobial susceptibility of Prevotella species as determined by Etest methodology","volume":"52","author":"Ulger Toprak","year":"2018","journal-title":"Anaerobe"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.2217\/fmb-2019-0132","article-title":"Multidrug resistance in anaerobes","volume":"14","author":"Boyanova","year":"2019","journal-title":"Future Microbiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1016\/j.anaerobe.2010.07.004","article-title":"Trends in antibiotic resistance in Prevotella species from patients of the University Hospital of Maxillofacial Surgery, Sofia, Bulgaria, in 2003-2009","volume":"16","author":"Boyanova","year":"2010","journal-title":"Anaerobe"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"i1","DOI":"10.1136\/thx.2004.030676","article-title":"BTS guidelines for the management of pleural infection in children","volume":"60","author":"Balfour-Lynn","year":"2005","journal-title":"Thorax"},{"key":"ref21","first-page":"6","article-title":"Observation on the efficacy of moxifloxacin combined with metronidazole in the treatment of lung abscess","volume":"7","author":"Liu","year":"2020","journal-title":"Clin Med Lit Electron J"},{"key":"ref22","first-page":"267","article-title":"Metagenomic next-generation sequencing identifies Prevotella pulmonary infection: a case report","volume":"32","author":"Zeng","year":"2021","journal-title":"Hainan Med J"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1097\/01.SMJ.0000140855.39444.07","article-title":"Vertebral osteomyelitis caused by Prevotella (Bacteroides) melaninogenicus","volume":"98","author":"Mukhopadhyay","year":"2005","journal-title":"South Med J"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1016\/j.bjid.2012.10.008","article-title":"Vertebral osteomyelitis and epidural abscesses caused by Prevotella oralis: a case report","volume":"16","author":"Goyal","year":"2012","journal-title":"Braz J Infect Dis"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.inat.2017.07.003","article-title":"Spondylodiscitis caused by Prevotella intermedia: a case report and literature review","volume":"10","author":"Opoku-Darko","year":"2017","journal-title":"Interdiscip Neurosurg"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1007\/s11011-017-0142-x","article-title":"A chinese case of prevotella intermedia and streptococcus constellatus intracranial mixed infection","volume":"33","author":"Mo","year":"2018","journal-title":"Metab Brain Dis"},{"key":"ref27","first-page":"189","article-title":"Two cases of lung abscess caused by rare anaerobic infection and literature review","volume":"12","author":"Li","year":"2022","journal-title":"China Med Pharm"},{"key":"ref28","first-page":"234","article-title":"Analysis of clinical characteristics of lung abscess caused by Prevotella infection","volume":"10","author":"Zhang","year":"2022","journal-title":"Chin J Diagn (Electron Ed)"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"S13","DOI":"10.1038\/sc.2014.197","article-title":"Spinal intradural abscess caused by hematogenous spread of Prevotella oralis in a 3-year-old child with an asymptomatic congenital spinal abnormality","volume":"53","author":"Karatay","year":"2015","journal-title":"Spinal Cord"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.anaerobe.2016.11.009","article-title":"Clinical characteristics and antimicrobial susceptibilities of anaerobic bacteremia in an acute care hospital","volume":"43","author":"Tan","year":"2017","journal-title":"Anaerobe"},{"key":"ref31","first-page":"305","article-title":"Prevotella bloodstream infection: a 10-year single-center retrospective study","volume":"23","author":"Zhou","year":"2024","journal-title":"Chin J Infect Control"},{"key":"ref32","first-page":"86","article-title":"Misdiagnosis analysis and literature review of spinal infection caused by Prevotella intermedia","volume":"23","author":"Wang","year":"2024","journal-title":"Chin J Infect Control"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/0002-9343(93)90115-6","article-title":"Anaerobic osteomyelitis and arthritis in a military hospital: a 10-year experience","volume":"94","author":"Brook","year":"1993","journal-title":"Am J Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"102111","DOI":"10.1016\/j.anaerobe.2019.102111","article-title":"Antimicrobial susceptibility profiles of anaerobic bacteria, isolated from human clinical specimens, within different European and surrounding countries. A joint ESGAI study","volume":"61","author":"Veloo","year":"2020","journal-title":"Anaerobe"},{"key":"ref35","first-page":"56","article-title":"Analysis of CT imaging features of atypical lung abscess","volume":"15","author":"Lin","year":"2017","journal-title":"Chin J CT MRI"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1888298\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T15:50:46Z","timestamp":1784821846000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1888298\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":35,"alternative-id":["10.3389\/fmed.2026.1888298"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1888298","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]},"article-number":"1888298"}}