Streptococcal Meningitis Following Myelogram Procedures

Abstract

In September of 2004, we investigated 7 cases of post-myelography meningitis. Streptococcal species were recovered from blood or cerebrospinal fluid in all cases. Our findings suggest that droplet transmission of the oral flora of the clinician performing the procedure was the most likely source of these infections. The Centers for Disease Control and Prevention recommends the use of face masks by those performing myelograms.

Outbreak of Bacterial Meningitis Among Patients Undergoing Myelography at an Outpatient Radiology Clinic

“…Although we did not detect S salivarius in the iohexol vials, not all vials used for casepatients were available for testing. Previous investigations of post-myelography bacterial meningitis had not identified multiple cases on the same day or vial contamination [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] but only noted lack of facemask use [1,3,9,13,15]. In our investigation, the detection of 3 cases on 1 day suggests that additional factors, such as reusing potentially contaminated vials between patients, could have contributed to transmission.…”

“…Bacterial meningitis represents an uncommon but serious adverse event after myelography [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Numerous reports have attributed these infections to lapses including nonadherence to facemask (eg, may be labeled as surgical, medical procedure, or isolation mask) use among health care personnel (HCP) performing myelograms [1,3,[9][10][11][12][13]15]. On October 27, 2010, an orthopedic surgeon notified the Missouri Department of Health and Senior Services (DHSS) regarding 3 patients hospitalized with suspected meningitis after undergoing myelography at an outpatient radiology clinic (clinic A) on October 25.…”

Group A Streptococcal Meningitis in a Patient with Palmoplantar Pustulosis

“…The one-month history of persistent upper airway symptoms in our patient implies a subacute to chronic infection, which may have altered the balance of the microbial population and provoked the hematogenous spread of GAS from the upper respiratory mucosa. Additionally, head injuries, including cranial surgery, have been reported to be predisposing factors for this disease, although the reasons for this phenomenon remain unclear (10)(11)(12). In this case, the patient had undergone cranial surgery two months before admission, which could have triggered the GAS meningitis.…”

Endophthalmitis After Injections of Anti–Vascular Endothelial Growth Factor Drugs

“…5,6 Only after a series of 8 postmyelography streptococcal meningitis infections (masks were not worn by 7 of the physicians) did the Centers for Disease Control mandate (2005) the wearing of masks during lumbar punctures. 7,8 Though this practice has become the standard of care, data showing lower infection rates with the use of face masks have not been forthcoming and individual cases continue to be reported. 9 Though McCannel and Moshfeghi reported different overall endophthalmitis rates (1 in 4,059 vs. 1 in 8,617), the rates because of streptococcal species were quite similar (1 in 13,192 vs. 1 in 12,064).…”