Spondylodiscitis and paraspinal abscess caused by β-haemolytic group G streptococci spreading from infected leg ulcers

Abstract

We report a case of spondylodiscitis due to Streptococcus dysgalactiae subsp. equisimilis spreading from infected leg ulcers. The route of infection could be unequivocally demonstrated by culturing identical isolates from leg wounds, blood culture and intra-surgery specimens from the spine. The present case illustrates the pathogenic potential of group G streptococci also for nondiabetic adults. Case reportIn January 2006, a 59-year-old male patient was admitted to the Department of Orthopaedics of the Rostock University Hospital with extreme lower back pain. He had been suffering from increasing back pain for about 3 months and had experienced three to four episodes of fever up to 40 u C lasting 1-2 days within the last 6 months. He had lost 40 kg of weight without intention during the previous year.Careful history taking revealed a history of coronary heart disease, a myelodysplastic syndrome with refractive anaemia, chronic recurrent pancreatitis and a seminoma (relapse-free for 14 years). The patient had also suffered from leg ulcers for about 9 months due to circulatory disturbances of both legs and a post-thrombotic syndrome after a pelvic vein thrombosis years ago.On admission, we saw a critically ill, moderately obese patient (89 kg/173 cm) who was alert and fully oriented. Body temperature was slightly elevated (37.4 u C). The blood pressure was normal at 105/60 mmHg. The heart sounds, skin aspect and nails beds as signs for endocarditis as well as results from transthoracic echocardiography were unremarkable. Arterial pulses were palpable except for the Aa. dorsalis pedis on both sides. There were leg ulcers on both legs with clinical signs of bacterial infection such as inflamed rims, pus, smear and odour (Fig. 1). The microbiological cultures from superficial swab material taken from both legs grew b-haemolytic group G streptococci (GGS; Streptococcus dysgalactiae subsp. equisimilis) and Staphylococcus aureus. Other parameters of the physical examination were unremarkable.The lower spine was sensitive to percussion. Symmetrical radicular pain was reported to reach from the rear side of the thighs to the knees concordant with dermatomes L5 being affected. The deep tendon reflexes of the legs were slowly releasable equally on both sides. Motor strength and sensory function were normal. The patient was continent.On admission, the white blood cell count was slightly elevated with 12.4610 9 cells l 21 (normal range 4-9610 9 cells l 21 ). Other infection parameters such as C-reactive protein (241 mg l 21 ; normal ,5 mg l 21 ), procalcitonin (2.42 ng ml 21 ; normal ,0.5 ng ml 21 ) and erythrocyte sedimentation rate (105 mm h 21 ) were remarkably elevated.The red blood cell count showed a normocytic anaemia with decreased values for haemoglobin (4.5 mmol l 21 ; normal range 8.6-12 mmol l 21 ) and haematocrit (23 %; normal range 40-51 %); thrombocytes were normal (334610 9 cells l 21 ). Liver enzymes were within the normal range except for an elevated alkaline phosphatase (182 U l 21 ; normal range 38-126 U l...

Group “G” B-Hemolytic Streptococcus a New Important Causative Organism of Localised Intra-Abdominal Abscess

“…infections by GGS had positive blood cultures as seen by other workers [2,[4][5][6] as high as 41% (128/314 cases) as reported by [6]. A history of skin infections/disruption of skin barrier [2][3][4][5][6] was seen in twothirds cases of GGS bacteremias 53% being second only to Group A streptococcus 58% infections [6] Group C streptococcus Large colony generally include several species like S. Dysgalactae, S. equisimilis, S. zooepidemicus and S. equi [7].…”

“…A history of skin infections/disruption of skin barrier [2][3][4][5][6] was seen in twothirds cases of GGS bacteremias 53% being second only to Group A streptococcus 58% infections [6] Group C streptococcus Large colony generally include several species like S. Dysgalactae, S. equisimilis, S. zooepidemicus and S. equi [7]. Average length of stay for all diabetic patients with GGS infections all over the body was longer (14.6) days than those who were not having diabetes mellitus [6].…”

Spondylodiscitis Caused by <i>Streptococcus dysgalactiae</i> Subspecies <i>Equisimilis</i>: A Case Report of an Increasingly Recognized Pathogenic Organism

“…It usually results from hematogenous seeding of the bone. Skin and soft tissue infections, urinary tract infections, endocarditis, respiratory tract infections and indwelling catheter-associated infections are the most common primary sources [4].…”

“…A thorough search of the literature (under the keywords "spondylodiscitis", "vertebral osteomyelitis" in combination with "Streptococcus dysgalactiae or Streptococcus equisimilis") revealed twelve published cases of spondylodiscitis involving SDSE as causative agents [4]- [11]. Not all of them had known underlying diseases recognized as risk factors.…”

Soft tissue infection caused by Streptococcus dysgalactiae subsp. equisimilis possessing group Aantigen: a and review of the literature

“…The portal of entry for SDSE may be venous ulcers of legs [59]. Some works reported recurrent bacteremia induced by SDSE [55].…”