Mouawad Yara, El-Hussein Mahmoud, Kalaji Joelle, Nasrallah Patrick, Hamieh Cima, Revue Eric
Lebanese American University Medical Center, Beirut, Lebanon.
Emergency Medicine Department, APHP-Lariboisiere Hospital, Paris, France.
Case Rep Infect Dis. 2025 Jun 8;2025:9468161. doi: 10.1155/crdi/9468161. eCollection 2025.
Iatrogenic meningitis is a rare but increasingly reported condition, particularly following invasive spinal procedures. The incidence is uncertain, ranging from none to two cases per 10,000 operations. Most cases involve infections with viridans streptococci. Septic meningitis presents with neurologic symptoms and elevated white blood cell counts in the cerebrospinal fluid (CSF), potentially leading to significant long-term neurologic damage or death if not promptly treated. A 32-year-old previously healthy male presented with severe headache, phonophobia, photophobia, nuchal rigidity, and fever, one day after undergoing anterior cruciate ligament (ACL) reconstructive surgery under spinal anesthesia. Initial evaluation revealed a Glasgow Coma Scale (GCS) score of 11, leukocytosis with neutrophilia, and turbid CSF with 3200 WBC/mm, 100% neutrophils, and Gram-positive diplococci identified Blood cultures confirmed the same pathogen. The patient was diagnosed with meningoencephalitis, likely contracted via the spinal anesthesia procedure. Despite initial deterioration requiring intubation and intensive care, the patient responded well to targeted antibiotic therapy and was discharged in stable condition. The clinical outcome of iatrogenic bacterial meningitis significantly depends on the virulence of the infecting organism. High-virulence pathogens have been associated with higher mortality rates, whereas infections caused by low-virulence bacteria like viridans streptococci generally have a more favorable prognosis. The infection likely occurred due to contamination during the spinal anesthesia procedure, despite the use of standard aseptic precautions. This underscores the importance of stringent infection control measures, including the use of face masks, thorough handwashing, sterile gloves, and appropriate skin antisepsis. This case highlights the potential for meningoencephalitis following spinal anesthesia, a rare but serious complication. Adhering to stringent aseptic guidelines and protocols is critical to prevent such infections. Prompt diagnosis and treatment are essential to mitigate the risks of severe neurologic damage and improve patient outcomes. Further research is needed to better understand the infection control measures that can prevent iatrogenic meningitis in spinal procedures.
医源性脑膜炎是一种罕见但报告日益增多的病症，尤其是在进行侵入性脊柱手术后。其发病率尚不确定，每10000例手术中从无病例到有两例不等。大多数病例是由草绿色链球菌感染引起的。化脓性脑膜炎表现为神经系统症状以及脑脊液（CSF）中白细胞计数升高，如果不及时治疗，可能会导致严重的长期神经损伤或死亡。一名32岁此前健康的男性在脊髓麻醉下进行前交叉韧带（ACL）重建手术后一天，出现严重头痛、畏声、畏光、颈部强直和发热症状。初步评估显示格拉斯哥昏迷量表（GCS）评分为11分，白细胞增多伴中性粒细胞增多，脑脊液浑浊，白细胞计数为3200个/mm，中性粒细胞占100%，并发现革兰氏阳性双球菌。血培养证实为同一病原体。该患者被诊断为脑膜脑炎，可能是通过脊髓麻醉程序感染的。尽管最初病情恶化需要插管和重症监护，但患者对针对性抗生素治疗反应良好，出院时病情稳定。医源性细菌性脑膜炎的临床结果很大程度上取决于感染病原体的毒力。高毒力病原体与较高的死亡率相关，而由草绿色链球菌等低毒力细菌引起的感染通常预后较好。尽管采取了标准的无菌预防措施，但感染可能是由于脊髓麻醉过程中的污染所致。这凸显了严格的感染控制措施的重要性，包括使用口罩、彻底洗手、无菌手套和适当的皮肤消毒。本病例突出了脊髓麻醉后发生脑膜脑炎的可能性，这是一种罕见但严重的并发症。遵守严格的无菌指南和规程对于预防此类感染至关重要。及时诊断和治疗对于降低严重神经损伤风险和改善患者预后至关重要。需要进一步研究以更好地了解可预防脊柱手术中医源性脑膜炎的感染控制措施。
