ISSN 0972-978X 

 
 
 
 
 
 
 
 
 
 
 
 
  About COAA
 

 

 

 

 

 

 

CASE REPORT

A very rare spontaneous group-C Streptococcal constellatus spondylodiscitis: A case report

Ravinder Gangone, Iain Findlay, Prabhat Reddy Lakkireddi, Gavin Marsh

Mayday University Hospital, Surrey.

Address for Correspondence:
Iain Findlay
Dept of Orthopaedics & Trauma, Mayday University Hospital
530, London Road, Thornton Heath,
Surrey. CR7 7YE

Phone :
0044-208-401-3455
Fax     : 0044-208-401-3100
E-mail: findlayiain@hotmail.com

Abstract:
Background
:
Streptococcus infection was originally thought to be a rare cause of spondylodiscitis, but recent literature shows that the incidence is on rise.
Objective:
We describe a previously unreported case of group-C Streptococcal constellatus spondylodiscitis.
Case Report
:
A 72 year old male presented with a 4 week history of worsening back pain with no neurological deficit. Inflammatory markers were raised and an MRI scan was suggestive of spondylodiscitis at the T10/11 level. A CT guided biopsy lead to culture of Streptococcus constellatus. Treatment was with IV antibiotics and bed rest with a full recovery achieved.
Conclusion: The culture of the pathogenic organism following CT guided biopsy was essential in this case. The spectrum of infection has yet to be completely described for Streptococcus constellatus. Early diagnosis and treatment with sensitive antibiotics can prevent the evolution of drug resistant Streptococcus in the future.

J.Orthopaedics 2009;6(3)e7

Keywords:
Spondylodiscitis; Streptococcus constellatus; Streptococcal infection.

 

Introduction:

We describe a previously unreported case of group-C Streptococcal constellatus spondylodiscitis. Discitis is mostly blood borne and has higher risk in the old, debilitated and intravenous drug addicts. A history of pneumonia, urinary tract infection, skin infection or immunocompromise is common.

The most common organism is Staphylococcus aureus in 50-75% of cases. Escherichia coli and Proteus sp. are more common in patients with urinary tract infections, Pseudomonas aeruginosa and Klebsiella species are common in intravenous drug addicts1. Streptococcus infection was originally thought to be a rare cause, but recent literature shows that the incidence is on rise2,3,4,5.

Case Report 

A 72 year old male presented to his general practitioner with a worsening history of pain in the lower back for 4 weeks. The pain initially started after gardening, without a history of trauma or constitutional symptoms. There was no radiation of pain and no bowel or bladder disturbance.

On examination, there was marked paraspinous muscle spasm and lower thoracic spine tenderness with restriction of flexion and extension. There was no sensory or motor deficit and all reflexes were normal.

Inflammatory markers were raised  (white cell count of 10.2× 109/lt, erythrocyte sedimentation rate of 30mm/hr and a C reactive protein of 20). An MRI of the thoraco-lumbar spine showed marked oedema at T10/T11 with high signal seen in the disc and erosion of end plates, changes consistent with discitis (Figure 1). 

An urgent CT guided biopsy of T10/T11 level grew Strep.constellatus sensitive to penicillin, erythromycin, vancomycin and a synergistic infection with Strep. viridans. AFB staining and culture were negative. 

Treatment was with intravenous antibiotics and bed rest. The back pain resolved in 2 weeks and his inflammatory markers returned to normal, with a full recovery made.

Figure 1. MRI scan of the T10/11 disc with high signal seen in the disc and erosion of end plates, changes consistent with discitis.

 

Discussion :

Strep.constellatus is a gram positive group-C β haemolytic microaerophyllic streptococcus known to cause upper body abscesses and respiratory infections, especially in immunocompromised individuals6. It is a recently discovered subclass of Strep. milleri with more virulent characteristics. Strep. constellatus species works synergistically with other streptococci bacteria. Their ability to produce capsular material acts a protective shield from the body’s defences. The complete clinical spectrum of infections caused by this subspecies has yet to evolve.

A literature search did not find any previous reported cases of Strep. constellatus spondylodiscitis. As it is microaerophyllic, the organism can survive well in an oxygen-depleted environment causing subacute spondylodiscitis. Lack of clinical suspicion can delay diagnosis. This case highlights the importance of doing CT guided biopsy in all cases of disctis.

Spectrum of infection has yet to be completely described and Strep.constellatus should be considered as serious pathogen in bone infection. Early diagnosis and treatment with sensitive antibiotics can prevent the evolution of drug resistant Streptococcus in the future.

Reference :

  1. Cottle L, Riordan T. Infectious Spondylodiscitis. J Infect 2008; 56(6):401-12.

  2. Jacobs JA, Pieterson HG, Walkenkamp GH, Stobberingh EE, Soeters PB. Intervertebral infection caused by Streptococcus milleri- A case report. Clin Orthop Relat Res. 1994; 302:183-8.

  3. Meyes E, Flipo RM, Van Bosterhaut B, Mouligneau G, Duquesnoy B, Delcambre B. Septic Streptococcus milleri spondylodiscitis: J. Rheumatol.1990 ;17(10): 1421-3.

  4. Balsam LB, Shepherd GM, Rouff KL.Streptococcus anginosus spondylodiscitis: Clin Infect Dis. 1997; 24(1): 93-4.

  5. Narváez J, Pérez-Vega C, Castro-Bohorquez FJ, Vilaseca-Momplet J. Group B streptococcal spondylodiscitis in adults- 2 case reports: Joint Bone Spine. 2004; 71(4):338-43.

  6. Fuentes Olmo J, Ruiz Mariscal M, Uribarrena Amezaga R, Omiste Sanvicente T. Spontaneous bacterial peritonitis due to Streptococcus constellatus. Gastroenterol Hepatol. 2006; 29(9):595-6.

 

This is a peer reviewed paper 

Please cite as: Iain Findlay: A very rare spontaneous group-C Streptococcal constellatus spondylodiscitis: A case report

J.Orthopaedics 2009;6(3)e7

URL: http://www.jortho.org/2009/6/3/e7

ANNOUNCEMENTS

 


 

Arthrocon 2011


Refresher Course in Hip Arthroplasty

13th March,  2011

At Malabar Palace,
Calicut, Kerala, India

Download Registration Form

For Details
Dr Anwar Marthya,
Ph:+91 9961303044

E-Mail:
anwarmh@gmail.com

 

Powered by
VirtualMedOnline

 

 

   
© Copyright of articles belongs to the respective authors unless otherwise specified.Verbatim copying, redistribution and storage of this article permitted provided no restrictions are imposed on the access and a hyperlink to the original article in Journal of Orthopaedics maintained. All opinion stated are exclusively that of the author(s).
Journal of Orthopaedics upholds the policy of Open Access to Scientific literature.