Veillonella parvula Discitis and Secondary Bacteremia: a Rare Infection Complicating Endoscopy and Colonoscopy?

Abstract

We report a case of Veillonella parvula lumbar discitis and secondary bacteremia confirmed by molecular characterization of the 16S rRNA genes. Identification of the organism was essential for an appropriate choice of antimicrobial therapy following the failure of empirical flucloxacillin. Veillonella spp. are normal flora of the gastrointestinal tract, raising the possibility that an endoscopy and colonoscopy performed 8 weeks prior to presentation, during which small intestinal and rectal biopsies were obtained, was the portal of entry. This case highlights the importance of obtaining a microbiologic diagnosis, particularly in patients who previously have had procedures involving instrumentation. CASE REPORTA 55-year-old school headmaster presented to the Emergency Department of St. Vincent's Hospital, Sydney, Australia, with a 48-h history beginning with the sudden onset of severe lower back pain. There was no history of injury or trauma. The pain was associated with night sweats, and he described an episode of shaking consistent with rigors. There was no significant past medical history and no recent dental procedure was reported. He had undergone a routine endoscopy and colonoscopy for a slight change in bowel habits 2 months prior to presentation. There were no abnormal findings, but a small bowel biopsy and a rectal biopsy were obtained to exclude celiac disease and histologic colitis.On examination, the patient was initially afebrile, although his temperature rose to 38°C that night. No heart murmurs were present, and there were no peripheral stigmata of infective endocarditis. Dentition was normal, and no gingivitis was noted. Severe back pain was precipitated by minimal movement of the legs and trunk.On examination, moderate tenderness was noted over the lumbar spine and left lumbar paravertebral region. The neurological examination was limited by pain but was considered to be normal. The neutrophil count was 4.6 ϫ 10 9 /liter, but the erythrocyte sedimentation rate was 68 mm/h and the C-reactive protein (CRP) level was 211 mg/liter. An X-ray examination of the lumbar spine revealed degenerative changes at L3, L4, and L5. During the next 12 h the pain worsened, requiring narcotic analgesia, and urinary retention developed, necessitating bladder catheterization and an indwelling catheter. Two sets of blood cultures were collected, and antimicrobial therapy was withheld pending a magnetic resonance imaging scan, which was performed 18 h after admission. The magnetic resonance imaging scan revealed multilevel disc destruction with posterior disc extrusions most severe at the L2/3 level, resulting in compression of the thecal sac and central canal stenosis at this level. No bony destruction was noted.Blood cultures remained negative 48 h after admission. A computed tomography-guided biopsy of the L2/3 disc was undertaken, with three fine-needle aspirate biopsies obtained using a 22-gauge needle. Following the biopsy, the patient was started on flucloxacillin and given a single 1-g dose of ceftriaxone. With...

Intragenomic and intraspecific heterogeneity in rrs may surpass interspecific variability in a natural population of Veillonella

“…Species of the genus Veillonella are usually regarded as early colonizers and highly represented members of the human microbiome, particularly in the mouth (Könönen et al, 1999) and the gut (Favier et al, 2002;Zilberstein et al, 2007), and are frequently detected during cultureindependent studies of the diversity of different microbiotae during health and disease (Paster et al, 2001;Wang et al, 2004;Aas et al, 2005;Preza et al, 2008). More frequently isolated from human clinical specimens in aerobic-anaerobic polymicrobial cultures, these bacteria were recovered in pure culture and implicated in severe opportunistic human infections (Bhatti & Frank, 2000;Marchandin et al, 2001;Boo et al, 2005;Marriott et al, 2007). Molecular studies are required for species identification due to the lack of discriminating phenotypic tests.…”

Receptor Recognition of and Immune Intracellular Pathways for Veillonella parvula Lipopolysaccharide

“…The genus Veillonella was first isolated by Veillon and Zuber in 1898 and currently consists of eight species (28).…”

“…Veillonella species have been reported as causes of serious infections, including meningitis (6), osteomyelitis and discitis (7,28), prosthetic joint infection (26), and acute and chronic pleuropulmonary infection (33).…”

“…Risk factors for Veillonella infection include periodontal disease, immunodeficiency, intravenous drug use, and premature birth (28). V. parvula is an important pathogen implicated in periodontitis and other dental infections (3,18), and it is one of the most common anaerobic pathogens in chronic maxillary sinusitis and deep neck infections (9,37).…”

Contribution of Veillonella parvula to Pseudomonas aeruginosa-Mediated Pathogenicity in a Murine Tumor Model System

“…Thus, Veillonella species had been reported to be involved in mainly dental infections (13,14). In addition, severe acute and chronic infections, such as osteomyelitis and discitis (15)(16)(17)(18)(19), meningitis (15), prosthetic joint infection (20), pleuropulmonary infections (21), and abscessed orchiepididymitis with sepsis had been observed (22). Endovascular infections by Veillonella species are considered to range from bacteremia to severe endocarditis and fatal cases of sepsis (23)(24)(25)(26).…”