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Detection of Staphylococcus aureus by 16S rRNA directed in situ hybridisation in a patient with a brain abscess caused by small colony variants
  1. F Kipp1,
  2. W Ziebuhr3,
  3. K Becker1,
  4. V Krimmer1,
  5. N Höβ2,
  6. G Peters1,
  7. C von Eiff1
  1. 1Institute of Medical Microbiology, Hospital and Clinics, University of Münster, Germany
  2. 2Department of Neurosurgery, Hospital and Clinics, University of Münster
  3. 3Institute for Molecular Infectious Biology, University of Würzburg, Würzburg, Germany
  1. Correspondence to:
 Dr Christof von Eiff, Institute of Medical Microbiology, University of Münster, Domagkstraβe 10, 48149 Münster, Germany;


A 45 year old man was admitted to hospital with a right sided facial paralysis and three month history of seizures. Computed tomography showed a left temporal mass including both intracerebral and extracerebral structures. Ten years earlier the patient had undergone a neurosurgical intervention in the same anatomical region to treat a subarachnoid haemorrhage. In tissue samples and pus obtained during neurosurgery, Staphylococcus aureus was detected by a 16S rRNA-directed in situ hybridisation technique. Following long term cultivation, small colony variants (SCV) of methicillin resistant S aureus were identified. The patient was treated successfully with a combination of vancomycin and rifampin followed by prolonged treatment with teicoplanin, with no sign of infection on follow up nine months after discharge. This is the first report in which S aureus SCV have been identified as causative organisms in a patient with brain abscess and in which in situ hybridisation has been used to detect S aureus in a clinical specimen containing SCV. Antimicrobial agents such as rifampin which have intracellular activity should be included in treatment of infections caused by S aureus SCV.

  • brain abscess
  • Staphylococcus aureus
  • small colony variants
  • in situ hybridisation

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