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Clostridium perfringens: a rare cause of postoperative spinal surgery meningitis
T Kristopaitis1, R Jensen, M Gujrati
1Department of Pathology, Loyola University Medical Center, Maywood, Illinois 60153, USA.
Background:
Clostridium perfringens is a rare cause of central nervous system infections, particularly meningitis. The case of a 76-year-old man who developed fatal C. perfringens meningitis after routine decompressive laminectomy for spinal stenosis is described.
Case Report:
Twelve days after surgery the patient presented with pain and serosangiunous drainage from the surgical incision site. A swab of the drainage revealed Gram-positive bacilli; MRI of the lumbosacral spine showed the appearance of air around the laminectomy site. The patient died within 6 hours of presentation. Autopsy revealed acute cranial and spinal meningitis and choroid plexitis with organisms consistent with C. perfringens.
Conclusion:
No significant enteral pathology or source of endogenous infection was determined, suggesting postoperative wound contamination and meningeal seeding with this ubiquitous organism. Clostridial infection, although rare, should be considered in any patient with meningitis with a history of surgical intervention. Survival with minimal neurological deficits was achieved in half of the previously reported cases.
Insights
Clostridium perfringens meningitis is a rare but fatal complication following spinal surgery. Postoperative wound contamination led to this severe central nervous system infection in a 76-year-old man.
Area of Science:
- Neuroscience
- Infectious Diseases
- Medical Microbiology
Background:
- Clostridium perfringens is an uncommon cause of central nervous system infections.
- Meningitis is a rare manifestation of C. perfringens infections.
Observation:
- A 76-year-old man presented with surgical site infection 12 days post-laminectomy.
- Clinical presentation included pain, serosanguinous drainage, and radiographic evidence of air at the surgical site.
- The patient rapidly deteriorated and died within 6 hours of presentation.
Findings:
- Autopsy confirmed acute cranial and spinal meningitis and choroid plexitis.
- Organisms consistent with Clostridium perfringens were identified.
- No endogenous source of infection was found, indicating likely postoperative wound contamination.
Implications:
- Clostridial meningitis should be considered in patients with meningitis and a history of surgery.
- Early recognition and treatment are crucial, though outcomes can be severe.
- This case highlights the importance of sterile surgical techniques to prevent rare but devastating infections.