Bacterial meningitis without pyrexia after spinal anesthasia for caesarean section: A case report
1Department of Anesthesia, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia.
Introduction And Importancy:
Meningitis happening in post spinal anesthesia is rare. But it has potentially life threatening or permanent neurological sequel if delayed or left untreated. The cause can be infectious or noninfectious. In this case, uncommon pathogen is described causing bacterial meningitis. Incidence varies from 0% to 0.04%.
Case Presentation:
A term pregnant lady came to the Operation room (OR) for an emergency caesarian section(C/S) because of cervical dystocia. She has no history of known medical illness. The anesthetist planned to administer spinal anesthesia. Under aseptic technique, the senior anesthetist wore a tight-fitting surgical mask, cap, and sterile gloves after hand hygiene with alcohol-based solutions. In sitting positioning between L(lumbar) 3 and L4 interspaces 10 mg bupivacaine +10 μg fentanyl was administered. Surgery and anesthesia were uneventful, 16 h into the postoperative period the mother develop severe headache, agitation, confusion, and forgetfulness. She has no fever but meningeal sign was positive. Lumbar puncture (LP) reveals purulent cerebrospinal fluid (CSF). Immediately, empirical treatment began. CSF sent for analysis and Culture, hematology, urinalysis, and organ function tests requested. Diagnosis was confirmed by clinical picture, low CSF glucose, and high body fluid protein, culture growth; showed Escherichia coli (E.coli). Treatment was instituted and patient has recovered fully.
Clinical Discussion:
E.coli is a very rare cause of bacterial meningitis but manifests a similar clinical picture like other bacterial meningitis but in our case no pyrexia. We believe there is a sterility breach somewhere in the process. The use of hospital sterilized spinal set, multidose antiseptics; institute sterility practice might be challenged.
Conclusion:
The use of modern packaging is recommended. Despite absent of pyrexia empiric treatment must start earlier besides the application of national guideline developed by the Joint Commission of different associations including America society of regional anesthesia (ASRA) is recommended.
Insights
Post-spinal anesthesia meningitis is rare but serious. This case highlights an uncommon cause, Escherichia coli, emphasizing the need for strict sterility and early empiric treatment.
Area of Science:
- Anesthesiology
- Infectious Diseases
- Neurology
Background:
- Post-spinal anesthesia meningitis is a rare but potentially severe complication.
- Infectious causes are more common, but non-infectious etiologies also exist.
- Early diagnosis and treatment are crucial to prevent life-threatening or permanent neurological sequelae.
Purpose of the Study:
- To report a rare case of bacterial meningitis following spinal anesthesia.
- To discuss the causative agent, Escherichia coli, and its implications.
- To emphasize the importance of aseptic techniques and timely treatment in preventing meningitis after spinal anesthesia.
Main Methods:
- A case presentation of a term pregnant patient undergoing emergency cesarean section under spinal anesthesia.
- Detailed description of the anesthetic procedure, aseptic techniques employed, and postoperative monitoring.
- Diagnostic workup including lumbar puncture, cerebrospinal fluid analysis, and microbial culture.
Main Results:
- The patient developed symptoms of meningitis 16 hours post-anesthesia, including severe headache, agitation, confusion, and forgetfulness, despite the absence of fever.
- Cerebrospinal fluid analysis revealed purulent fluid with low glucose and high protein.
- Culture confirmed the presence of Escherichia coli as the causative pathogen.
Conclusions:
- Escherichia coli is an uncommon cause of bacterial meningitis post-spinal anesthesia, presenting similarly to other bacterial meningitis but potentially without fever.
- A breach in sterility during the procedure is suspected as the likely cause.
- Recommendations include the use of modern sterile packaging, early empiric treatment even without fever, and adherence to national guidelines for regional anesthesia.
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