Bacterial meningitis after dental extraction in a 17-year-old horse.

Dental extractions in horses may result in bacteremia, which can lead to systemic complications. Bacterial meningitis following oral cheek tooth extractions in a 17-year-old Thoroughbred gelding is described in this report. The bacterial meningitis was confirmed by histopathology. The gelding was presented for evaluation of intermittent fever, loose feces, and mild colic signs which started 5 days after cheek tooth extraction. This case illustrates a rare complication associated with oral tooth extraction in a horse and highlights the unusual presenting features of meningitis. Key clinical message: Bacterial meningitis secondary to oral cheek tooth extraction should be considered as differential diagnosis; particularly in cases with the development of pyrexia a few days after the procedure.

Méningite bactérienne après extraction dentaire chez un cheval de 17 ans. Les extractions dentaires chez les chevaux peuvent entraîner une bactériémie, ce qui peut amener des complications systémiques. Un cas de méningite bactérienne à la suite d'extractions buccales de dents jugales chez un hongre pur-sang de 17 ans est décrite dans ce rapport. La méningite bactérienne a été confirmée par histopathologie. Le hongre a été présenté pour évaluation d'une fièvre intermittente, de selles molles et de signes de coliques légers qui ont commencé 5 jours après l'extraction de la dent jugale. Ce cas illustre une complication rare associée à l'extraction dentaire orale chez un cheval et met en évidence des caractéristiques inhabituelles de la méningite.Message clinique clé :La méningite bactérienne secondaire à l'extraction buccale des dents jugales doit être considérée comme un diagnostic différentiel, en particulier dans les cas de développement d'une pyrexie quelques jours après l'intervention.(Traduit par Dr Serge Messier).

Bacterial meningitis after sinus surgery in five adult horses.

OBJECTIVE: To report meningoencephalitis as a complication after paranasal sinus surgery in 5 horses. STUDY DESIGN: Case series. ANIMALS: Adult horses (n = 5). METHODS: Medical records (2005-2010) of 5 horses that developed neurologic signs after sinus surgery were reviewed to identify potential risk factors, cause(s), or common pathways for infection. RESULTS: Underlying diseases were primary (n = 1) and secondary sinusitis (4) because of apical dental infection (1), sinus cyst (2), or masses in the ethmoturbinate region (2). Horses were treated by conventional surgical approaches and aftercare including repeated sinus lavage. Four horses had undulating pyrexia postoperatively despite antimicrobial therapy. All horses developed neurologic signs, eventually unresponsive to treatment. Suppurative meningoencephalitis was diagnosed macro- and/or microscopically on necropsy in all horses. CONCLUSION: Meningitis is a rare but fatal complication after sinus surgery in horses.

Consensus on Implants in Infections After Spine Surgery.

In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 9 focused on implants questions in spine surgery, for which this article provides the recommendations, voting results, and rationales.

[A case report of streptococcus oralis meningitis after dental manipulation].

A 75-year-old man was admitted to our hospital because of high fever and disturbance of consciousness 4 days after dental treatment including scaling, irrigation, and oral antibiotic for dental caries without gingivitis. A lumber puncture revealed cloudy cerebrospinal fluid (CSF): it contained 984 leukocytes/mm3, 680 mg/dl of protein, 5 mg/dl of glucose (blood sugar 233 mg/dl), and Streptococcus oralis, one of common microorganisms on the gingival, was isolated from the CSF. He was successfully treated with intravenous antibiotics. The authors believe this patient's meningitis developed as a result of bacteremia after the dental scaling in the present case.

Purulent pansinusitis, orbital cellulitis and rhinogenic intracranial complications.

OBJECTIVES: Acute pansinusitis is rarely seen in the maxillofacial surgery field, but often occurs in combination with orbital and intracranial involvement. Clinically this entity is of great importance, since it represents a severe disease with possibly disastrous consequences. PATIENTS: Aetiology, diagnosis and therapy of acute pansinusitis and its complications were analysed in 36 patients treated surgically from 1987 to 1996. RESULTS: Eighteen patients were aged between 3 and 21-years-old. Only eight suffered from pure pansinusitis, and three of an isolated purulent orbital infection. Of these 25 patients 20 had (pan-)sinusitis with orbital, three with intracranial, and two with both orbital and intracranial complications. Intracranial involvement included meningitis, empyema and brain abscess. Aetiology was rhinogenic in 26, odontogenic in six patients, and traumatic in two cases. Radiological work-up included conventional radiographs and CT in most cases, MRI was only used with special indications. Microbiological examination detected single or multiple species of micro-organisms with equal frequency. If multiple species were found, infection was mostly aerobic/anaerobic in combination. CONCLUSION: These purulent processes, frequently seen in young patients, require immediate surgical intervention and drainage with elimination of the cause of the disease if possible. Cooperation with other specialities is essential depending on the spread of the disease. In spite of the threatening acute symptoms, severe courses of disease or permanent defects should be avoidable.

A rare complication of dental treatment: Streptococcus oralis meningitis.

A case of Streptococcus oralis meningitis is reported. This followed extraction of a normal tooth during routine orthodontic treatment. No focus of infection could be demonstrated, either local to or distant from the extraction site. Full recovery followed hospital admission and intravenous benzyl penicillin.

Osteomyelitis of the odontoid process associated with meningitis and retropharyngeal abscess--case report.

A 52-year-old man complaining of headache and nuchal pain was treated initially under a diagnosis of bacterial meningitis. The meningitis resisted antibiotic therapy, and one week later was complicated by a ruptured retropharyngeal abscess, which led to the correct diagnosis of osteomyelitis of the odontoid process of the axis. His neck was immobilized in a high neck collar and the retropharyngeal abscess was treated by repeated drainage and irrigation. A long course of antibiotic administration finally resolved the infection. Osteomyelitis of the odontoid process is rare and presents with peculiar signs and symptoms. Careful consideration of the differential diagnosis is needed for the early detection of this potentially serious condition.

[Acute bacterial meningitis and foramen magnum syndrome as a presentation of odontoid osteomyelitis. A case report].

A 77-year-old male was hospitalized with a 6-day history of severe posterior cervical pain and headache. An initial lumbar puncture revealed polymorphonuclear pleocytosis indicating pyogenic meningitis. The blood and throat cultures on admission were positive for Staphylococcus aureus. A combination of ceftriaxone and ABPC, both of which were sensitive to the pathogen, were intravenously administered for one month, by which he responded well as to the meningitis. However, he was found to have persistent neck pain, and wasting and weakness of the shoulder girdles, which were associated with polyneuropathy-like sensory loss. Neuroimaging studies disclosed a partial destruction of the odontoid process, subluxation of the atlantoaxial joint, MRI evidence of an inflammatory pseudomass formation dorsal to the odontoid process and an increased uptake of radionuclide on bone scanning, all of which were indicative of osteomyelitic processes at the region of the axis; i.e., the meningitis was thought to be secondary to osteomyelitis of the odontoid process and hence the foramen magnum syndrome characteristic to this particular case was explained by the compression of the cervicomedullary junction due to the pseudomass. To our knowledge, this is the first case of primary odontoid osteomyelitis to be reported in Japan.

[An adult case of purulent meningitis secondary to retropharyngeal and deep neck abscess after treatment of odontogenic infection].

Retropharyngeal and deep neck abscess, which may follow odontogenic infection, is uncommon in adults, but can be fatal. Furthermore, bacterial meningitis secondary to this disorder is extremely rare. A 67-year-old man was brought to our hospital because he had developed neck pain, trismus, and disturbance of consciousness over several days. A few days prior to the appearance of neck pain, he had the periodontitis treated. Based on CSF, cervical X-ray and CT findings, he was diagnosed as having bacterial meningitis secondary to deep neck abscess. Culture of the CSF yielded gram-positive cocci, later identified as Gemella species, that is a rare organism for bacterial meningitis. Although the administration of antibiotics and drainage of the abscess resulted in gradual improvement of the infectious process, neurologically he remained with apallic syndrome. We would like to stress the importance of odontogenic and pharyngolaryngogenic sources as potential foci of purulent meningitis.

[Meningitis is a rare complication of spinal anesthesia. Good hygiene and face masks are simple preventive measures]. / Meningit ovanlig komplikation i samband med spinalanestesi. God hygien och munskydd enkla förebyggande åtgärder.

Although bacterial meningitis is a rare sequela of spinal anaesthesia, occasional case reports continue to appear in anaesthesiological literature. The article presents nine cases of iatrogenic meningitis reported to the treatment injury claims authority. Eight of these patients had undergone spinal anaesthesia, and one myelography. Alpha-haemolytic streptococci were isolated in cerebrospinal fluid culture in seven cases, the remaining two cases being culture-negative. Although alpha-haemolytic streptococci are normal commensals of the upper respiratory tract and mouth and rarely cause spontaneous meningitis, they have been implicated in several reported cases of iatrogenic meningitis. The risk of such infection raises the issue of the widespread habit of omitting face masks when performing dural puncture. As these bacteria are not known to cause infection in general surgery, the necessity of using face masks in the operating theatre has been questioned. However, the use of face masks has been shown to reduce the risk of bacterial contamination from the upper airway; and as available documentation on iatrogenic meningitis suggests oral commensals to be responsible, the use of face masks should be mandatory whenever any kind of lumbar puncture is performed.

Streptococcus sanguis meningitis: report of a case and review of the literature.

Viridans streptococcus, an indigenous bacterial species of the mouth and gastrointestinal tract, is thought to be a rare cause of bacterial meningitis. The type of streptococcus involved is important because each type causes a different kind of meningitis and is associated with a different outcome. A 39-year-old previously healthy man was admitted due to the onset of acute purulent meningitis. A cerebrospinal fluid culture grew Streptococcus sanguis (S. sanguis). Although the patient was asymptomatic for dental caries, odontogenic maxillary sinusitis was found to be the cause of the meningitis. Treatment with intravenous antibiotics was successful. Following a review of the pertinent literature, we discuss the characteristics of S. sanguis meningitis.

Bacterial meningitis after tooth extraction.

Wound infections after tooth extraction may occur in up to 5%. A systemic infection is a rare but threatening complication often caused by an underlying immune deficiency (immunosuppression, diabetes, HIV) which requires prompt adequate care. This case report describes bacterial meningitis as a possible systemic complication two days after the extraction of a molar in a patient with previously undiagnosed latent diabetes mellitus.

Post-dural puncture bacterial meningitis.

A fatal case of viridans streptococcus meningitis is reported, which occurred as a complication of epidural anesthesia. One hundred seventy-nine reported cases of post-dural puncture meningitis are reviewed. Evidence suggests that most cases are probably caused by contamination of the puncture site by aerosolized mouth commensals from medical personnel, some are caused from contamination by skin bacteria, and, less frequently, other cases are caused directly or hematogenously by spread from an endogenous infectious site. Controversy exists regarding prevention, surveillance, incidence, and treatment of this serious complication.

Beware of dogs licking ears.

A patient with right-sided chronic purulent otorrhoea developed meningitis due to Pasteurella multocida transmitted by a dog that frequently licked his ear. We suggest that patients with a perforated tympanic membrane should avoid being licked on their ears by animals.

Subdural empyema after tooth extraction in which Capnocytophaga species was isolated.

We describe a patient with meningitis and a subdural empyema arising from an infection after teeth extraction in which Capnocytophaga species was detected. The patient was a 54-y-old man without any underlying diseases. A computerized tomography scan showed a subdural empyema 21 d after the extraction.

Escherichia coli 0111 B4 lipopolysaccharide given intracisternally induces blood-brain barrier opening during experimental neonatal meningitis in piglets.

Neonatal bacterial meningitis remains a life-threatening infection, and severe neurologic sequelae may be left in survivors as well. The goal of the study was to develop and characterize a porcine model of the disease with intravital observation of the permeability changes in cerebral microvessels. Eighteen newborn piglets were given doses of 0 ng (group 1), 20 ng (group 2), and 200 ng (group 3) of Escherichia coli 0111 B4 endotoxin (LPS) intracisternally (n = 6 in each group). Cardiovascular parameters were without changes, but a compensated metabolic acidosis occurred in group 3 4 h after LPS injection. Using the open cranial window technique combined with fluorescence excitation, there was no blood-brain barrier leakage in pial-arachnoid microvessels for sodium fluorescein during the 4 h of experiments in group 1 piglets, whereas spotty extravasations occurred in group 2 and in group 3 after the LPS injections (70.5 +/- 10.5 and 55.2 +/- 4.1 min, respectively, mean +/- SEM). A dose-dependent increase in sodium fluorescein uptake in brain regions examined (parietal and occipital cortex, cerebellum, and periventricular white matter) was also found by fluorescence spectrophotometry. LPS-treated piglets had developed pleocytosis. Four h after the challenge, the white blood cell counts in cerebrospinal fluid were (mean +/- SD): group 1, 8.2 +/- 7.6 microL-1; group 2, 453 +/- 703 microL-1; and group 3, 1 027 +/- 620 microL-1, respectively, whereas there was no change in white blood cell count of peripheral blood samples.(ABSTRACT TRUNCATED AT 250 WORDS)

Perfil etiológico e terapêutico da meningite bacteriana aguda: contribuindo para a vigilância dos serviços de saúde / Bacteria profile and therapeutic of acute bacterial meningitis: contribuition for health services

Com o objetivo de identificar as bactérias e as associações dos antibióticos utilizadas na meningite bacterina aguda, foram investigados 243 prontuários de pacientes internados de 2000 a 2002 no Hospital Giselda Trigueiro, em Natal (RN-Brasil). Os dados foram analisados pela freqüência percentual. Foi constatado que, em 79,4 por cento dos prontuários, a cultura foi indeterminada. Nas idades até 60 meses, houve uma redução do Haemophilus influenzae. De 6 a 14 anos, 15 a 25 anos e maiores de 26 anos, predominou a Neisseria meningitidis. Até os 12 meses, foi constatado o uso da ceftriaxona. De 13 a 60 meses, da ampicilina seguida da ceftriaxona. De 6 a 14 anos, predominou a ampicilina, seguid pelo uso profilático da rifampicina. A partir dos 15 anos, predominou a ampicilina. O estudo chama atenção para o grande número de prontuários sem o resultado da cultura. Dessa forma, este achado traz implicações para os serviços de saúde, suscitando a necessidade de se reavaliarem os métodos de diagnóstico utilizados.