Iatrogenic Meningitis Caused by Neisseria sicca/subflavaafter Intrathecal Contrast Injection, Australia

Damoon Entesari-Tatafi

, Mohammad Bagherirad, Doreen Quan, and Eugene Athan

Author affiliations: Barwon Health, Geelong, Victoria, Australia

Abstract

We report a case of invasive Neisseria sicca/subflava meningitis after a spinal injection procedure during which a face mask was not worn by the proceduralist. The report highlights the importance of awareness of, and adherence to, guidelines for protective face mask use during procedures that require sterile conditions.

Neisseria sicca/subflava is a known commensal bacterium of the upper respiratory tract and has rarely been found to cause meningitis, endocarditis, or bacteremia (1,2). There is limited literature describing the clinical course and optimal management of iatrogenic meningitis caused by N. sicca/subflava. Infections of the central nervous system caused by this organism occur rarely; most reported cases are in the pediatric population (3,4). In the literature describing illness in adults, 4 cases of N. sicca meningitis are described, 1 of which was an iatrogenic case: a complication of ventriculostomy (5). Of 2 case reports of iatrogenic N. subflava meningitis (6,7) 1 case occurred 48 hours after intrathecal injection in a young immunocompetent female patient (7).

Iatrogenic meningitis is a well-documented complication of lumbar puncture and carries an estimated mortality of ~35% extrapolated from a US data review (8). Most cases occur after catheter insertion or injection into the intrathecal space, but infection related to diagnostic lumbar puncture is less common. The most frequently identified causative organisms in samples are Streptococcus salivarius, Streptococcus viridans and other α-hemolytic streptococci,Staphylococcus aureus, and Pseudomonas spp. (9).

Multiple case reports of iatrogenic meningitis associated with nonuse of face masks prompted a review of the evidence by the Healthcare Infection Control Practices Advisory Committee, which advises US Health and Human Services. The result was a recommendation for the routine use of face masks for clinicians placing a catheter or injecting material into the epidural or spinal space, which was included in the guideline, 2007 Safe Injection Practices to Prevent Transmission of Infection to Patients (10). After subsequent outbreaks, the US Centers for Disease Control and Prevention released a clinical reminder in 2011 (11).

Dr Entesari-Tatafi is an advanced trainee in adult acute care medicine (general medicine) and a dual trainee in intensive care medicine at Barwon Health, Geelong, Australia. His primary research interests are clinical audit and improvement.

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Suggested citation for this article: Entesari-Tatafi, D, Bagherirad M, Quan D, Athan E. Iatrogenic meningitis caused by Neisseria sicca/subflava after intrathecal contrast injection, Australia. Emerg Infect Dis. 2014 Jun [date cited]. http://dx.doi.org/10.3201/eid2006.131117