Spinal epidural abscess from group A Streptococcus after varicella infection: a case report and review of the literature

Abstract

This is the third case of SEA from GAS reported in the literature in a pediatric population with varicella infection. We discuss here the clinical presentation and the diagnostic challenges for SEA in childhood through a review of the literature.

Review and case report demonstrate that spontaneous spinal epidural abscesses are rare but dangerous in childhood

“…Also, in our case study, the CSF examination yielded pleocytosis, hypoglycorrhachia and elevated protein, but the CSF culture was sterile and polymerase chain reaction tests for common bacterial causes of meningitis were negative. It should be noted that lumbar punctures should not typically be performed in cases of suspected or confirmed SEA, as the procedure may result in further seeding of the infection .…”

“…There are very few reports of paediatric SEA in the literature . Haematogenous spread from an intercurrent febrile illness, such as tonsillitis, pharyngitis, pneumonia, acute otitis media, skin and soft tissue infections, is the favoured route of infection, especially in infants and young children .…”

“…Invasive procedures are implicated in 15% of cases. No source of infection can be identified in up to 20–40%, suggesting silent bacteraemia seeding the epidural space .…”

Thoracic spinal epidural abscess caused by fishbone perforation

“…SEA is an infection that forms in the space between the bones of the spine and the lining membrane of the spinal cord. [16] In this study, a thoracic SEA case was presented with a clearly different mechanism from that of cervical SEA. The esophagus is located in the septum.…”

Spinal infections in children: A review

“…27 Reports have suggested that varicella infection may increase the risk for spinal epidural abscesses due to secondary bacterial. [28][29][30] Infection with poliovirus, herpes virus, and cytomegalovirus (especially in patients with HIV) can also result in myelitis. With interruption of wild poliovirus circulation from many parts of the world, myelitis associated with it has decreased in the recent years.…”