Vertebral osteomyelitis and epidural abscesses caused by Prevotella oralis: a case report

Abstract

An interesting case of pyogenic vertebral osteomyelitis with multiple epidural abscesses caused by non-pigmented Prevotella oralis is reported. The patient was a 68-year-old female who presented to the emergency room (ER) with severe pain and tenderness in her lower back with fever. She had recently undergone esophagogastroduodensoscopy (EGD) for complaints of esophageal reflux, which showed submucosal cyst in the esophagus. Magnetic resonance imaging (MRI) of the thoracic spine revealed multiple spinal epidural abscesses with signal enhancement at the level of T6 and T7, suggestive of vertebral osteomyelitis. Two blood cultures drawn one hour apart grew Prevotella oralis. The body fluid aspirated from the abscesses was also positive for the anaerobic commensal P. oralis. Necrosis associated with the submucosal cyst was implicated as the cause of sepsis and osteomyelitis due to this organism.

Unveiling the Pathogenic Bacteria Causing Descending Necrotizing Mediastinitis

“…Frequently detected aerobic pathogens are Streptococcus , Enterococcus , Klebsiella , and Staphylococcus aureus , and the most common anaerobes are Streptococcus pepticus , Streptococcus pyogenes , and Prevotella ( Ridder et al., 2010 ; Palma et al., 2015 ). In the present study, P. oris , a non-pigmented, specialized anaerobic bacterium that often causes infections in abscesses, wounds, and soft tissues, was highly abundant in both samples ( Goyal et al., 2012 ; Cahalan et al., 2013 ). P. oris can resist antibiotic treatments and produce more extensive infections in previously infected areas by binding or attaching to cells other than epithelial cells ( Shah and Collins, 1990 ).…”

Spinal intradural abscess caused by hematogenous spread of Prevotella oralis in a 3-year-old child with an asymptomatic congenital spinal abnormality

“…1 The most common cause of spinal infections are Staphylococcus aureus and beta hemolytic Streptococcus, whereas anaerobic Gramnegative bacilli (AGNB) are extremely rare. 2 In this study, we reported the first case of spinal intradural abscess caused by the hematogenous spread of Prevotella oralis, an AGNB, which has not been described as a single isolate of the intradural abscess in literature.…”

“…There was no spinal infection caused by the Prevotella oralis in that study. 3 Goyal et al 2 reported an adult patient who had vertebral osteomyelitis and spinal epidural abscess due to Prevotella oralis. Simon et al reported a 13-month-child patient who was operated for spinal intradural cyst, dermal sinus and spinal intradural abscess.…”

Prevotella osteomyelitis after dental capping procedure

“…Vertebral osteomyelitis from Prevotella species has been described in six case reports from 1997 to present with P. oralis being described once. The case of P. oralis vertebral osteomyelitis was described in a patient with a necrotic submucosal cyst in the esophagus causing sepsis [5]. The use of anabolic steroids may have made him more susceptible to infection [6].…”