Emergent Meningoencephalitis Following Spinal Anesthesia: A Case Report

TL;DR

A rare case of meningitis following spinal anesthesia is reported, emphasizing the need for strict infection control and prompt treatment.

Contribution

This case report adds to the understanding of iatrogenic meningitis risks after spinal procedures and highlights infection control measures.

Findings

A 32-year-old male developed meningitis after spinal anesthesia for ACL surgery, caused by Streptococcus salivarius.

The patient recovered after targeted antibiotic therapy despite initial deterioration.

The case underscores the importance of aseptic techniques to prevent such infections.

Abstract

Background: 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.

Case Presentation: 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/mm2, 100% neutrophils, and Gram-positive diplococci identified as Streptococcus salivarius. 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.

Discussion: 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.

Conclusion: 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.

Figures