Streptococcus salivarius kot povzročitelj iatrogenega meningitisa – predstavitev primera

We present a case of a 28-year-old patient who underwent spinal anaesthesia for caesarean section, and developed meningitis, Streptococcus salivarius was isolated in the cerebrospinal fluid. The Viridans streptococci are a part of a normal human mouth flora, therefore the patient most likely developed iatrogenic meningitis due to droplet transmission of bacteria intrathecally. We discuss etiology, pathogenesis, clinical presentation, diagnostic tools, treatment and prognosis of meningitis afer intrathecal procedures and we emphasize the importance of strict aseptic technique while performing neuraxial procedures. Iatrogenic meningitis should be considered as a possible differential diagnosis in patients who present with symptoms and signs of meningitis after neuraxial blockade.

Outbreak of bacterial meningitis after spinal anaesthesia in Bangladesh

Iatrogenic meningitis following spinal anaesthesia is very rare. Recently we have experienced severe headache, vomiting, fever, restlessness, nuchal rigidity and altered level of consciousness 5-6 hours after spinal anaesthesia in one hundred and nineteen patients diagnosed as iatrogenic bacterial meningitis during the period of September 2008 to March 2009. Patients were successfully treated with Inj. Ceftriaxone 2gm BID for 14 days, Inj. Dexamethasone 20mg daily in four divided dose for five days. Purulent CSF, high cell count (1570mm-3), elevated protein level (269mg/dl) and normal glucose (57mg/dl) levels in CSF were noted. There were 5 (4.2%) cases of mortality. No causative organisms were isolated from CSF, blood of the affected patients and anaesthetic agent used for the block. In conclusion, the cause of meningitis was diagnosed as bacterial in origin though no organism was isolated. DOI: http://dx.doi.org/10.3329/jbsa.v22i1.18084 Journal of BSA, 2009; 22(1): 5-11

Iatrogenic meningitis

Iatrogenic meningitis can be caused by a number of mechanisms. The recent case reports of fungal meningitis after application of epidural methylprednisolone caused warning in the medical community. Cases were caused by contaminated lots of methylprednisolone from a single compounding pharmacy. Several medications can cause meninigitis by probable hypersensitivity mechanism. Neurologists should be alert to the recent description of the use of lamotrigine and development of aseptic meningitis.

Bacterial Contamination in Solution Aspirated from Non-Sterile Packaged Fentanyl Ampoules: A Laboratory Study

Iatrogenic meningitis is a rare complication of spinal anaesthesia. It is mandatory to use a technique which minimises the risk of introducing bacteria into the subarachnoid space. Currently available fentanyl ampoules require a careful drawing-up technique, as the outside of the ampoule is not sterile and there is potential to contaminate the contents in the drawing-up process. We designed a pilot laboratory study to determine the extent of bacterial contamination of fentanyl solutions drawn up from non-sterile packaged glass fentanyl ampoules using three different methods: aspirating through a 5 μm filter needle only, aspirating through a 5 μm filter needle after swabbing the neck of the ampoule with isopropyl alcohol and aspirating through an antibacterial filter in addition to the 5 μm filter needle. Ten anaesthetists used each method once, in randomised order, to draw up solution from three different fentanyl ampoules. Samples underwent bacterial culture in blood agar and enrichment broth for 48 hours. No significant growth was seen in any sample. This pilot study did not identify any bacterial contamination of fentanyl solution irrespective of which of the three methods for aspiration was used.