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Alpha-hemolytic streptococci: A major pathogen of iatrogenic meningitis following lumbar puncture. Case reports and a review of the literature

Alpha-hämolysierende Streptokokken: Wichtiger Erreger der iatrogenen Meningitis nach Lumbalpunktion. Fallberichte und Literaturübersicht

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Summary

Iatrogenic meningitis following lumbar puncture is a rare complication of myelography, spinal anesthesia, intrathecal chemotherapy, and epidural anesthesia. Sporadic cases and clusters of iatrogenic meningitis have been reported after intrathecal therapy, but most incidental cases are reported after myelography. Four cases of iatrogenic meningitis caused by viridans streptococci and a review of the literature are presented here. Observations and a case control study implicated a single anesthesiologist as the source. Probable cause of this cluster is non-observance of infection control measures as to the routine wearing of masks during the procedure. New infection control guidelines were implemented. A review of the literature on iatrogenic meningitis is given. Viridans streptococci have emerged as major pathogens of this complication. These findings underline the need to wear face masks since these bacteria are commensals of the oral cavity.

Zusammenfassung

Eine iatrogene Meningitis nach Lumbalpunktion ist eine seltene Komplikation bei Myelographie, intrathekaler Chemotherapie und spinaler, sowie epiduraler Anaesthesie. Kasuistiken von Fällen von iatrogener Meningitis sind nach intrathekaler Applikation beschrieben, kommen aber am häufigsten nach Myelographie vor. Wir berichten über vier Patienten mit iatrogener Meningitis verursacht durch viridans Streptokokken und geben eine Übersicht über die Literatur. Beobachtungen und eine Fall-Kontroll-Studie verwiesen auf einen Anaesthesisten als Verursacher der Infektionen. Der wahrscheinliche Grund der Häufung der Fälle war das Nichteinhalten von Hygienevorschriften, insbesondere das Tragen eines Mund-/Nasenschutzes. Neue Hygienevorschriften wurden eingeführt. Auch aus der Literaturübersicht gehen vergrünende Streptokokken als einer der wichtigsten Erreger der iatrogenen Meningitis hervor. Da diese Mikroorganismen zur Normalflora des Nasen-Rachenraumes gehören, empfehlen wir das Tragen eines Mund-Nasenschutzes.

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Authors and Affiliations

  1. Dept. of Medical Microbiology, Bosch Medicentrum, Nieuwstraat 34, NL-5211 's, Hertogenbosch

    P. M. Schneeberger M. D. & M. Janssen

  2. Dept. of Medical Microbiology, University Hospital Nijmegen, Nijmegen, The Netherlands

    A. Voss M. D., Ph. D.

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  1. P. M. Schneeberger M. D.
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  2. M. Janssen
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  3. A. Voss M. D., Ph. D.
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Schneeberger, P.M., Janssen, M. & Voss, A. Alpha-hemolytic streptococci: A major pathogen of iatrogenic meningitis following lumbar puncture. Case reports and a review of the literature. Infection 24, 29–33 (1996). https://doi.org/10.1007/BF01780647

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  • DOI: https://doi.org/10.1007/BF01780647

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