Case report of spinal epidural abscess caused by Haemophilus paraphrophilus

Scerpella, Ernesto G.; Wu, Shun Yao; Oefinger, Paul E.

doi:10.1128/jcm.32.2.563-564.1994

Cited by 8 publications

(2 citation statements)

References 9 publications

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“…El absceso epidural es una complicación rara, su incidencia varía de 0.2-2/10,000 admisiones hospitalarias (1)(2)(3)(4) , en otras publicaciones mencionan 1/506,000 pacientes obstétricas con catéter epidural (3,(5)(6)(7) , la presentación en niños es rara, con menos de 90 casos publicados (2,8,9) . No obstante, existen múltiples factores para que se desarrolle esta entidad como diabetes mellitus (9)(10)(11) , uso de drogas intravenosas, insuficiencia renal crónica, alcoholismo, cáncer, hepatopatía e inmunosupresión (1,2,11) ; en obstetricia es la ruptura de membranas con signos de corioamnionitis (2) , la colocación del catéter epidural, inserción dificultosa del mismo o varios intentos, punciones hemáticas, uso de apósitos de poliuretano para fijarlo y el tiempo de permanencia del catéter, el cual es colonizado desde las dos horas de la colocación (3,10,12) (2) , Mycobacterium tuberculosis (13) , Neisseria gonorrhoeae (14) , Haemophilus paraphrophilus (15,16) ; sin embargo, existen casos en los que no fue posible identificar el agente causal (7,17) . El tiempo de aparición de la sintomatología varía de tres días hasta cinco meses y la triada clásica es fiebre, dolor de espalda y signos de afectación radicular con deterioro neurológico progresivo (18) .…”

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Absceso epidural en una paciente obstétrica

Larios-Camacho¹

2020

Revista Mexicana De Anestesiología

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RESUMEN.El absceso epidural es una complicación rara que puede ser causa de una elevada morbimortalidad, por ello es fundamental el diagnóstico y tratamiento oportunos. Nuestra paciente desarrolló un absceso posterior a un bloqueo epidural para una cesárea, la técnica anestésica se realizó en condiciones de asepsia y antisepsia, y se retiró el catéter al terminar la cirugía; fue dada de alta a las 48 horas. Reingresa a los nueve días por presentar fiebre, dolor en miembro pélvico izquierdo y dehiscencia de herida quirúrgica. La resonancia magnética mostró un absceso epidural en L3-L4. Se realizó laminectomía y el cultivo mostró Escherichia coli, fue manejada con antibióticos intravenosos durante cuatro semanas y se dio de alta sin secuelas neurológicas. ABSTRACT.Spinal epidural abscess is a rare complication, it can be cause a high morbimortality and the prompt diagnosis and treatment is essential. Our patient present an abscess after epidural block for caesarean section, the anesthetic procedure was in aseptic technique and the catheter was withdrawn after surgery, the patient was discharged after 48 hours. She was readmitted nine days later with fever, left leg pain and wound surgery infection. The magnetic resonance showed a spinal epidural abscess in L3-L4. Underwent laminectomy cultured showed Escherichia coli, she was at hospital by intravenous antibiotic treatment for 4 weeks and she was discharged without neurologic sequelae. Palabras clave:Absceso epidural, bloqueo epidural.

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Section: Discussionunclassified

Absceso epidural en una paciente obstétrica

Larios-Camacho¹

2020

Revista Mexicana De Anestesiología

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“…), it is an uncommon cause of human disease, but has been occasionally implicated in subacute endocarditis, osteomyelitis, brain and liver abscesses, and fatal pneumonitis (Le Gangneux et al, 1993;Watkin et al, 2003;Rabaud et al, 1995;Jensen & Hojbjerg, 1985, Howard, 1981. Only 3 cases of spondylodiscitis and spinal abscess have been reported to date (Samuel et al, 1997;Scerpella et al, 1994;Wilson et al, 1994), although the literature showed 15 cases of vertebral infection caused by H. aphrophilus (Colson et al, 2001). The nature of this bacterium means that, in clinical specimens, it may remain undetected unless appropriate microbiological methods are used.…”

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confidence: 99%

Cervical spondylodiscitis with spinal epidural abscess caused by Aggregatibacter aphrophilus

Pasqualini

Mencacci

Scarponi

et al. 2008

Journal of Medical Microbiology

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Spondylodiscitis caused by Aggregatibacter aphrophilus, formerly known as Haemophilus paraphrophilus, is an unusual condition and can be very difficult to diagnose. We report a case of cervical spondylodiscitis complicated by spinal epidural abscess in a 63-year-old woman, without underlying predisposing conditions. The source of infection was identified as a periodontal infection. The patient was successfully treated with systemic antibiotics. Case reportA 63-year-old woman was admitted to the Internal Medicine Section, University of Perugia Medical School, in January 2007 because of cervical back pain of increasing intensity, and 7 days remittent fever (39 u C). She reported progressive weakness of the left upper arm with decreased strength in her grip. The family physician had prescribed 500 mg acetaminophen orally twice a day, 75 mg diclofenac intramuscularly twice a day and 250 mg clarithromycin orally twice a day with no improvement of clinical picture. The patient had a history of mild chronic cervical back pain for several years, and a previous radiograph of the cervical spine showed chronic degenerative changes. The patient had undergone tooth extraction 3 months previously.At the hospital admission, she was febrile (39 u C), and physical examination showed resisted neck flexion and weakness of the distal left upper extremity; cardiac auscultation demonstrated an apical murmur, 2/6 intensity. Laboratory tests showed leukocytosis (13 900 leukocytes mm 23 with 90 % neutrophils) and elevation of erythrocyte sedimentation rate (77 mm h 21 ) and Creactive protein levels (116 mg l 21 ). After cerebral computed tomography, the patient underwent a lumbar puncture. Cerebrospinal fluid pressure was normal, and biochemical analysis revealed increased protein levels (187 mg dl 21 ), with normal glucose and no leukocytes. A magnetic resonance imaging (MRI) scan of the cervical spine demonstrated an abnormal signal intensity at the level of C6-C7 vertebral bodies and at the intersomatic disc. The pre-contrast sequences also demonstrated signal alterations involving the perivertebral soft tissues from C4 to T1. Gadolinium injection showed pathological enhancement of meninges from C4 to T1, and an anteriorparamedian epidural abscess at the level of the C6-C7 intersomatic disc, not compressing the spinal cord (Fig. 1). An initial empiric antimicrobial therapy, with 400 mg teicoplanin endovenously once a day and 500 mg imipenem-cilastatin endovenously three times a day, was started; Schanz collar was used for cervical spine immobilization. Electromyography showed severe acute axonal injury at the C7-C8-T1 levels. Neurosurgical evaluation excluded the need for decompressive laminectomy or debridement of infected tissues.Cultures of the cerebrospinal fluid were negative, while blood samples (two sets from different vein punctures), collected immediately on admission in BACTEC Plus aerobic and anaerobic bottles (Becton Dickinson), flagged positive (aerobic bottles) after 6 days of incubation for small Gram-negative coccobac...

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Spinal epidural abscess: a meta-analysis of 915 patients

Waldbaur²,

2000

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Spinal epidural abscess (SEA) was first described in the medical literature in 1761 and represents a severe, generally pyogenic infection of the epidural space requiring emergent neurosurgical intervention to avoid permanent neurologic deficits. Spinal epidural abscess comprises 0.2 to 2 cases per 10,000 hospital admissions. This review intends to offer detailed evaluation and a comprehensive meta-analysis of the international literature on SEA between 1954 and 1997, especially of patients who developed it following anesthetic procedures in the spinal canal. In this period, 915 cases of SEA were published. This review is the most comprehensive literature analysis on SEA to date. Most cases of SEA occur in patients aged 30 to 60 years, but the youngest patient was only 10 days old and the oldest was 87. The ratio of men to women was 1:0.56. The most common risk factor was diabetes mellitus, followed by trauma, intravenous drug abuse, and alcoholism. Epidural anesthesia or analgesia had been performed in 5.5% of the patients with SEA. Skin abscesses and furuncles were the most common source of infection. Of the patients, 71% had back pain as the initial symptom and 66% had fever. The second stage of radicular irritation is followed by the third stage, with beginning neurological deficit including muscle weakness and sphincter incontinence as well as sensory deficits. Paralysis (the fourth stage) affected only 34% of the patients. The average leukocyte count was 15,700/microl (range 1,500-42,000/microl), and the average erythrocyte sedimentation rate was 77 mm in the first hour (range 2-50 mm). Spinal epidural abscess is primarily a bacterial infection, and the gram-positive Staphylococcus aureus is its most common causative agent. This is true also for patients who develop SEA following spinal anesthetics. Magnetic resonance imaging (MRI) displays the greatest diagnostic accuracy and is the method of first choice in the diagnostic process. Myelography, commonly used previously to diagnose SEA, is no longer recommended. Lumbar puncture to determine cerebrospinal fluid protein concentrations is not needed for diagnosis and entails the risk of spreading bacteria into the subarachnoid space with consequent meningitis; therefore, it should not be performed. The therapeutic method of choice is laminectomy combined with antibiotics. Conservative treatment alone is justifiable only for specific indications. Laminotomy is a therapeutic alternative for children. The mortality of SEA dropped from 34% in the period of 1954-1960 to 15% in 1991-1997. At the beginning of the twentieth century, almost all patients with SEA died. Parallel to improvements in the mortality rate, today more patients experience complete recovery from SEA. The prognosis of patients who develop SEA following epidural anesthesia or analgesia is not better than that of patients with noniatrogenic SEA, and the mortality rate is also comparable. The essential problem of SEA lies in the necessity of early diagnosis, because only timely treatment is able to av...

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Case report of spinal epidural abscess caused by Haemophilus paraphrophilus

Cited by 8 publications

References 9 publications

Absceso epidural en una paciente obstétrica

Absceso epidural en una paciente obstétrica

Cervical spondylodiscitis with spinal epidural abscess caused by Aggregatibacter aphrophilus

Spinal epidural abscess: a meta-analysis of 915 patients

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