Iatrogenic streptococcus salivarius meningitis: a case report
DOI:
https://doi.org/10.6016/ZdravVestn.2216Keywords:
bacterial meningitis, subarachnoid anaesthesia, epidural anaesthesia, neuraxial blockade, Viridans group streptococcAbstract
We present a case of a 28-year-old patient who underwent spinal anaesthesia for caesarean section, and developed meningitis, Streptococcus salivarius was isolated in the cerebrospinal fluid. The Viridans streptococci are a part of a normal human mouth flora, therefore the patient most likely developed iatrogenic meningitis due to droplet transmission of bacteria intrathecally. We discuss etiology, pathogenesis, clinical presentation, diagnostic tools, treatment and prognosis of meningitis afer intrathecal procedures and we emphasize the importance of strict aseptic technique while performing neuraxial procedures. Iatrogenic meningitis should be considered as a possible differential diagnosis in patients who present with symptoms and signs of meningitis after neuraxial blockade.
Downloads
References
Strle F. Okužbe osrednjega živčevja. In: Tomažič J, Strle F, ur. Infekcijske bolezni. Ljubljana: Združenje za infektologijo; 2014. p. 199–232.
Baer ET. Post-Dural Puncture Bacterial Meningitis. Anesthesiology [Internet]. 2006;105(2):381–93. Available from: http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1931212.
Barnwell R, Ball V. Iatrogenic bacterial meningitis: an unmasked threat. CJEM 2012;14(4):259–62.
Wilson M, Martin R, Walk ST, Young C, Grossman S, McKean EL, et al. Clinical and laboratory features of Streptococcus salivarius meningitis: a case report and literature review. Clin Med Res. 2012;10(1):15–25.
Vintar N. Kako nevarne so blokade osrednjega živčevja? In: Novak Jankovič V, ur. Zbornik predavanj–Drugi slovenski kongres področne anestezije z mednarodno udeležbo; 2014 maj 16.-18.; Ljubljana, Slovenija. Ljubljana: Slovensko združenje za anesteziologijo in intenzivno medicino; 2014.
Sinner SW, Tunkel AR. Nutritionally variant Streptococci, Groups C and G Streptococci, and other related organisms. In: Mandell GL, Benett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia: Churchill Livingstone Elsevier; 2015.p. 2349–61.
Tunkel AR, Sepkowitz KA. Infections caused by viridans streptococci in patients with neutropenia. Clin Infect Dis. 2002;34(11):1524–9. Available from: http://cid.oxfordjournals.org/content/34/11/1524.long.
Chaffanel F, Charron-Bourgoin F, Libante V, Leblond-Bourget N, Payot S. Resistance Genes and Genetic Elements Associated with Antibiotic Resistance in Clinical and Commensal Isolates of Streptococcus salivarius. Appl Environ Microbiol. 2015;81(12):4155–63.
Shewmaker PL, Gertz RE Jr, Kim CY, Fijter S, DiOrio M, Moore MR, et al. Streptococcus salivarius Meningitis Case Strain Traced to Oral Flora of Anesthesiologist. J Clin Microbiol. 2010;48(7):2589–91.
Baer ET. Iatrogenic meningitis: the case for face masks. Clin Infect Dis 2000;31(2):519–21.
Rubin L, Sprecher H, Kabaha A, Weber G, Teitler N, Rishpon S, et al. Meningitis following spinal anesthesia: 6 cases in 5 years. Infect Control Hosp Epidemiol. 2007;28(10):1187–90.
Centers for Disease Control and Prevention (CDC). Bacterial Meningitis Afer Intrapartum Spinal Anesthesia: New York and Ohio, 2008–9. MMWR Morb Mortal Wkly Rep. 2010;28(3):1185–90.
Suy F, Verhoeven PO, Lucht F, Grattard F, Carricajo A, Pozzetto B, et al. Nosocomial meningitis due to Streptoccus salivarius linked to the oral flora of an anesthesiologist. Infect Control Hosp Epidemiol. 2013;34(3):331–2.
Enting RH, de Gans J, Blakevoort JP, Spanjaard L. Meningitis due to viridans streptococci in adults. J Neurol. 1997;244(7):435–8.
Lu CH, Chang WN, Chang HW. Adults with meningitis caused by viridans streptococci. Infection. 2001;29(6):305–9.
Lin TY, Chen WJ, Hsieh MK, Lu ML, Tsai TT, Lai PL, et al. Postoperative meningitis afer spinal surgery: a review of 21 cases from 20,178 patients. BMC Infect Dis. 2014;14(1):220.
van de Beek, Drake JM, Tunkel, AR. Nosocomial Bacterial Meningitis. N Engl J Med. 2010;362(2):146–154.
Smith-Hicks C. Developmental and Pregnancy-Related Changes in Cerebrospinal Fluid Dynamics and Composition. In: Irani DN, eds. Cerebrospinal Fluid in Clinical Practice. Philadelphia: Saunders Elsevier Health Sciences; 2009. p. 27–32.
Sharma K, Batra YK, Singh H. Effect of decreased cerebrospinal fluid proteins on the spread of local anaesthetic drugs in pregnancy. Indian J Med Res. 1990;92:175–7.
Bachmann-Harildstad G. Diagnostic values of beta-2 transferrin and beta-trace protein as markers for cerebrospinal fluid fstula. Rhinology. 2008;46(2):82–5.
Yaniv LG, Potasman I. Iatrogenic meningitis: an increasing role for resistant viridans streptococci? Case report and review of the last 20 years. Scand J Infect Dis. 2000;32(6):693–6.
Downloads
Published
Issue
Section
License
The Author transfers to the Publisher (Slovenian Medical Association) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Slovenian Medical Association) has the right to transfer the rights of acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.