Méningite après rachianesthésie

Varlet, C; Gorce, Philippe; Ouaknine, B; Pourriat, J.-L.

doi:10.1016/s0750-7658(00)90204-1

Cited by 7 publications

(1 citation statement)

References 7 publications

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“…La MI est une affection grave, mais heureusement elle reste un événement rare. Cette complication est surtout observée après une intervention neurochirurgicale [5,11,17] ou rarement après une PL à visée diagnostique, thérapeutique ou pour rachianesthésie [1,7,8,14,15].…”

Section: Discussionunclassified

Méningite bactérienne iatrogène après ponction lombaire de diagnostic: à propos de trois cas observés à l’hôpital d’enfants de Tunis

Smaoui¹,

Hariga²,

Hajji³

et al. 2010

Bull. Soc. Pathol. Exot.

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We have collected cases of iatrogenic meningitis managed in the Children's Hospital of Tunis, between January 1998 and December 2006. Clinical information about each patient were collected, all bacterial samples were investigated in the microbiology laboratory of the hospital. Bacterial isolates were identified according to conventional criteria. In the interval under study, we recorded three cases of iatrogenic meningitis after lumbar puncture. Two cases occurred in newborn admitted for suspicion of neonatal infection and one in a 2-month-old infant admitted for exploration of hyperpyretic convulsion. In all patients, the initial cerebrospinal fluid was normal. All patients developed symptoms of acute meningitis within 72 hours after lumbar puncture; the second cerebrospinal fluid was, then, typical for purulent meningitis. The causal agents isolated in the three cases were Klebsiella pneumoniae, Enterobacter cloacae, and Serratia marcescens, all resistant to beta-lactams by extended spectrum beta-lactamase production. The use of quinolones was required in all cases. Different complications were recorded: hydrocephalus and brain abscess in one case, respiratory and hemodynamic failure managed in the intensive care unit in the second, and brain hygroma in the third case. This study shows high morbidity of iatrogenic meningitis. Simple aseptic precautions undertaken before the procedure of lumbar puncture can prevent such cases. The urgent need for increasing the awareness among medical personnel in hospitals of developing countries cannot be overemphasized.

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Section: Discussionunclassified

Méningite bactérienne iatrogène après ponction lombaire de diagnostic: à propos de trois cas observés à l’hôpital d’enfants de Tunis

Smaoui¹,

Hariga²,

Hajji³

et al. 2010

Bull. Soc. Pathol. Exot.

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Two cases of chemical meningitis following spinal anesthesia

Nishimura

Tsubokawa

Kasama

et al. 2001

Journal of Anesthesia

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within the hospital. A puncture was made without any difficulty between L3 and L4 by using a disposable 25G needle for spinal anesthesia, and 2 ml of 0.3% dibucaine HCl was injected by using a 5-ml glass syringe that had been sterilized in the hospital. At the completion of the surgical procedure, the patient experienced mild nausea. In the ward 3 h after spinal anesthesia, she developed nausea, headache, a slight fever, and chills. Five hours later, her temperature returned to 37.6°C.A neurological examination was conducted the next day, and no abnormalities of the cranial nerves were recognized; however, headache, nuchal rigidity, and positive Kernig sign were noted. Hematological examination revealed an inflammatory state (white blood cell count, 9990 · mm Ϫ3 ; C-reactive protein, 2.6 mg·dl Ϫ1 ). The results of a lumbar puncture indicated the following: cerebrospinal fluid, slightly turbid; initial pressure, 175 mmH 2 0; cell counts 664/3 mm 3 (poly, 400 and mono, 264); protein, 152 mg·dl Ϫ1 ; sugar, 57 mg·dl Ϫ1 . The patient was treated with piperacillin sodium for 8 days under the diagnosis of meningitis. The cerebrospinal fluid culture yielded no bacterial growth. On the fifth day, she no longer suffered from neurological sequelae and was considered to have recovered completely. Case 2At 12 weeks and 6 days of pregnancy, a 24-year-old woman with cervical incompetence that had been caused by cervical conization was scheduled to undergo cervical cerclage under spinal anesthesia to prevent premature labor. Following handwashing and disinfection, the anesthetic procedure was performed in the same way as in Case 1 using the same drug and equipment set.Throughout the surgical procedure and after the patient was returned to the ward, no changes in vital signs were noted and she reported no subjective symptoms. However, nausea and vomiting developed 90 min and headache 2 h after spinal anesthesia. Twelve hours after

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