Alpha-hemolytic streptococci: A major pathogen of iatrogenic meningitis following lumbar puncture. Case reports and a review of the literature

Abstract

Iatrogenic meningitis following lumbar puncture is a rare complication of myelography, spinal anesthesia, intrathecal chemotherapy, and epidural anesthesia. Sporadic cases and clusters of iatrogenic meningitis have been reported after intrathecal therapy, but most incidental cases are reported after myelography. Four cases of iatrogenic meningitis caused by viridans streptococci and a review of the literature are presented here. Observations and a case control study implicated a single anesthesiologist as the source. Probable cause of this cluster is non-observance of infection control measures as to the routine wearing of masks during the procedure. New infection control guidelines were implemented. A review of the literature on iatrogenic meningitis is given. Viridans streptococci have emerged as major pathogens of this complication. These findings underline the need to wear face masks since these bacteria are commensals of the oral cavity.

Complicações neurológicas determinadas pela anestesia subaracnóidea

“…A fonte de infecção pode ser exógena, por meio de contaminação da pele (Stafilococcus) ou por germes contidos na oro- faringe (Streptococcus), ou endógena, secundária a infecções longe do local de punção. Foram descritos quatro casos de meningite iatrogênica, por Streptococcus, em período de 4 anos, após anestesias raquidianas realizadas pelo mesmo anestesiologista 48 . Em todos os casos o médico apresentava faringite recorrente e realizou o bloqueio sem máscara facial.…”

“…Infection sources may be exogenous, through skin contamination (Staphylococcus) or oropharyngeal germs (Streptococcus), or endogenous secondary to infections distant from the puncture site. Four iatrogenic Streptococcus meningitis cases in a 4-year period were described after spinal anesthesias performed by the same anesthesiologist 48 . In all cases, the physician had pharyngitis and induced blockade without facial mask.…”

Streptococcus salivarius meningitis after dental care: case report

“…Meningiti dovute a questa specie vengono descritte in poche occasioni (1,3). In questo studio riferiamo un caso recentemente diagnosticato nel nostro ospedale conseguente ad trattamento di una carie dentale.…”

Skin antisepsis guidelines – time to rethink the ‘rapid sequence spinal’?

“…The NAP3 project identified rare but potentially devastating complications of CNB such as epidural abscess and meningitis, in which poor aseptic technique was indicated [3]. Case reports have supported operator oropharyngeal commensals as the source for bacterial meningitis after spinal anaesthetic [4]; however, the use of surgical masks eliminates this infective source [5].…”

“…Recent guidelines on skin antisepsis for central neuraxial blockade are timely for practising anaesthetists [1], having been widely discussed in the literature following the devastating consequences suffered by previously fit, healthy individuals in three highly publicised cases [2][3][4].…”