[Streptococcus salivarius meningitis after spinal anesthesia].
ABSTRACT Streptococcus salivarius is a usual commensal of skin, gastrointestinal tract, genitourinary tract, oral cavity and paranasal sinuses. Although it is usually considered to have low virulence, S. salivarius may cause life-threatening infections, particularly endocarditis. On the other hand, bacterial meningitis after spinal anesthesia is very rare, there being some reported cases caused by S. salivarius, S. mitis, Staphylococcus aureus and Enterococcus faecalis. We report a 57 year old man who developed meningitis symptoms within 10 h of an uncomplicated inguinal herniorrhaphy performed during spinal anesthesia. Cerebrospinal cultures grew S. salivarius sensitive to penicillin. The patient was successfully treated with penicillin G and left the hospital without sequelae. In the literature, bacterial meningitis due to S. salivarius is rarely reported. Of the 28 cases, 18 occurred after lumbar puncture for diagnostic or for spinal anesthesia, 5 occurred following a bacteriemia for upper gastrointestinal endoscopy or intestinal neoplasia, and the other 5 in patients who had dural defects. We discuss the possible etiological causes of the meningitis due to S. salivarius cases reports. The early recognition of this entity and the aseptic precautions likely to reduce the incidence of infectious complications after lumbar puncture are stressed.
- SourceAvailable from: Mogens Kilian[Show abstract] [Hide abstract]
ABSTRACT: The aim of this study was to evaluate molecular and phenotypic methods for the identification of nonhemolytic streptococci. A collection of 148 strains consisting of 115 clinical isolates from cases of infective endocarditis, septicemia, and meningitis and 33 reference strains, including type strains of all relevant Streptococcus species, were examined. Identification was performed by phylogenetic analysis of nucleotide sequences of four housekeeping genes, ddl, gdh, rpoB, and sodA; by PCR analysis of the glucosyltransferase (gtf) gene; and by conventional phenotypic characterization and identification using two commercial kits, Rapid ID 32 STREP and STREPTOGRAM and the associated databases. A phylogenetic tree based on concatenated sequences of the four housekeeping genes allowed unequivocal differentiation of recognized species and was used as the reference. Analysis of single gene sequences revealed deviation clustering in eight strains (5.4%) due to homologous recombination with other species. This was particularly evident in S. sanguinis and in members of the anginosus group of streptococci. The rate of correct identification of the strains by both commercial identification kits was below 50% but varied significantly between species. The most significant problems were observed with S. mitis and S. oralis and 11 Streptococcus species described since 1991. Our data indicate that identification based on multilocus sequence analysis is optimal. As a more practical alternative we recommend identification based on sodA sequences with reference to a comprehensive set of sequences that is available for downloading from our server. An analysis of the species distribution of 107 nonhemolytic streptococci from bacteremic patients showed a predominance of S. oralis and S. anginosus with various underlying infections.Journal of Clinical Microbiology 01/2006; 43(12):6073-85. DOI:10.1128/JCM.43.12.6073-6085.2005 · 3.99 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: In recent years, there has been a considerable increase in the number of procedures carried out under regional anesthesia. The techniques used can be associated with a number of complications, which should be understood so that they can be recognized and managed appropriately. The overall incidence of reported complications associated with these techniques is low and therefore, with currently available data, we can only have an approximate idea of their incidence. The objective of this study is to systematically describe the complications that may arise from the use of neuraxial and peripheral regional anesthesia techniques.Revista espanola de anestesiologia y reanimacion 12/2008; 55(9):552-62.
- Enfermedades Infecciosas y Microbiología Clínica 04/2009; 27(6):372-3. DOI:10.1016/j.eimc.2008.12.002 · 2.17 Impact Factor