Iatrogenic meningitis by Streptococcus salivarius following lumbar puncture

Veringa, Etèl; Belkum, Alex van; Schellekens, Huub

doi:10.1016/0195-6701(95)90283-x

Cited by 75 publications

(45 citation statements)

References 10 publications

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“…S. salivarius is a commensal member of the oral mucosa, and many cases have been tracked to the oral microbiome of a healthcare provider performing a procedure on the case patient. 19,32,36 This suggests that droplet transmission or contamination of sterile equipment by the operator is an important mechanism for inoculation. Thus, strict practices of aseptic technique S. salivarius meningitis during these procedures and use of a facemask in accordance with guidelines as published by the Healthcare Infection Control Practices Advisory Committee and American Society of Regional Anesthesia and Pain Medicine will be important to limiting the incidence of these events.…”

Section: Outcome and Follow-upmentioning

confidence: 99%

Clinical and Laboratory Features of Streptococcus salivarius Meningitis: A Case Report and Literature Review

Wilson¹,

Ryan²,

Walk³

et al. 2011

Clinical Medicine & Research

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Streptococcus salivarius is a normal member of the human oral microbiome that is an uncommon cause of invasive infections. Meningitis is a rare but increasingly reported infection caused by S. salivarius. Despite the growing number of reported cases, a comprehensive review of the literature on S. salivarius meningitis is lacking. We sought to gain a better understanding of the clinical presentation, evaluation, management, and outcome of S. salivarius meningitis by analyzing previously reported cases. In addition to a single case reported here, 64 previously published cases of meningitis were identified for this review. The collected data confirm that most patients presented with classical signs and symptoms of bacterial meningitis with a predominance of neutrophils in the cerebrospinal fluid (CSF) and hypoglycorrhachia. The majority of cases followed iatrogenic or traumatic CSF contamination. Most cases were diagnosed by CSF culture within one day of symptom onset. There was no clear evidence of predisposing co-morbid conditions in patients with meningitis, although in most case reports, limited information was given on the medical history of each patient. Outcomes were generally favorable with antibiotic management. Clinicians should suspect S. salivarius meningitis in patients presenting acutely after medical or surgical procedures involving the meninges.

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Section: Outcome and Follow-upmentioning

confidence: 99%

Clinical and Laboratory Features of Streptococcus salivarius Meningitis: A Case Report and Literature Review

Wilson¹,

Ryan²,

Walk³

et al. 2011

Clinical Medicine & Research

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“…In our case, we presume that Streptococcus salivarius originated from the patient's skin or was aerosolised from the physician's mouth despite the face mask [18] or from the mouth of the nurse who had no face mask [8]. Others have identified this source with certainty [11,19].…”

Section: Discussionmentioning

confidence: 99%

“…............................................................................................................................................................................................................................................... because it is not a bacterial pathogen that commonly causes meningitis. However, although Streptococcus salivarius is a commensal of the skin, the genitourinary tract, the gastrointestinal tract and the oral cavity, meningitis due to Streptococcus salivarius is mainly associated with spinal anaesthesia [7,8] or myelography [9][10][11].…”

Section: Discussionmentioning

confidence: 99%

Pericardial placement of a pulmonary artery catheter

Cardwell

Winter

1998

Anaesthesia

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“…1 Veringa et al 2 reported a case of meningitis caused by Streptococcus salivarius that occurred iatrogenically after lumbar puncture. They identified the source of infection by isolating the same bacteria from the throat of the neurologist.…”

Section: Streptococcal Meningitis After Spinal Anesthesia: Report Of mentioning

confidence: 99%

“…1 administering large doses 2 and using the timing principle 3,4 have not been completely succesful. We have used a propofol-rocuronium mixture for the rapid induction of anesthesia.…”

mentioning

confidence: 99%

Streptococcal meningitis after spinal anesthesia: report of a case

Kocamanoğlu¹,

Şener²,

Tür³

et al. 2003

Can J Anesth/J Can Anesth

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Alternative strategies to reduce the onset time of nondepolarizing muscle relaxants, such as priming, 1 administering large doses 2 and using the timing principle 3,4 have not been completely succesful. We have used a propofol-rocuronium mixture for the rapid induction of anesthesia. First however, we tested whether a propofol-rocuronium mixture is stable.UV spectra were obtained on a Shimadzu UV 2100 sec spectrophotometer (10 mg·100 mL -1 in acetonitrile). A model 600 Waters pump was connected to a 200 µL loop injector and a µBondapak CN column (150 mm × 3.9 mm internal diameter; Waters assoc. Milford, MA, USA). Model 481 Waters UV detector and Unicam ProGC Data Station were used. Compounds were detected at 220 nm. The peak height was used for quantitation. The mobile phase was acetonitrile-water (60:40, v/v). The flow rate, injection volume and detector response were 0.7 mL·mL -1 , 5 µL and 15 µL and 100 mV, respectively.High pressure liquid chromatography (HPLC) method: standard stock solutions were freshly prepared with acetonitrile including 60 µg·mL -1 rocuronium bromide and 100 µg·mL -1 propofol. The external standard solutions were prepared with acetonitrile at a concentration of 60 µg·mL -1 for rocuronium bromide and at a concentration of 100 µg·mL -1 for propofol.Standard propofol peak height with a standard deviation of 0.38 and standard rocuronium bromide peak height with a standard deviation of 0.25 were established. Peak heights of propofol and rocuronium bromide in propofol-rocuronium bromide (5:3) stock solutions were determined at zero, two, four, six, 18, 24, 48 and 72 hr, respectively, in comparison to peak heights of the freshly prepared external standards at the same concentration level. We conclude that a 5:3 mixture of propofol and rocuronium bromide was stable up to 48 hr after mixing. Propofol concentration in the mixtures stored at ambient temperature showed degradation 72 hr after mixing. Propofol concentration in mixtures stored at 37°C showed degradation four hours after mixing.After Ethic's Committee approval and patient written informed consent, 35 patients, ASA class I-II, undergoing elective surgery were included in this study. All patients received fentanyl 1 µg·kg -1 followed by three minutes of preoxygenation. Anesthesia was then induced with the propofol (2 mg·kg -1 ) -rocuronium (0.6 mg·kg -1 ) mixture iv over 30 sec. All patients were intubated on the first attempt. The intubating conditions were evaluated using a score described by Viby-Mogensen. 5 Intubating conditions at 60 sec were determined as excellent in 26 patients and good in nine patients. We have not determined any adverse effect of this mixture.We concluded that anesthesia induction with a propofol-rocuronium mixture provides excellent or good intubating conditions at 60 sec. It could be an effective and alternative technique for rapid induction of anesthesia.

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Iatrogenic meningitis by Streptococcus salivarius following lumbar puncture

Cited by 75 publications

References 10 publications

Clinical and Laboratory Features of Streptococcus salivarius Meningitis: A Case Report and Literature Review

Clinical and Laboratory Features of Streptococcus salivarius Meningitis: A Case Report and Literature Review

Pericardial placement of a pulmonary artery catheter

Streptococcal meningitis after spinal anesthesia: report of a case

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