Vertebral osteomyelitis in bacterial meningitis patients

Abstract

ObjectiveTo analyze the clinical and laboratory characteristics of vertebral osteomyelitis in community-acquired bacterial meningitis patients. MethodsAll episodes of vertebral osteomyelitis in a cohort study of adult patients with community-acquired bacterial meningitis in the Netherlands were analyzed. Subsequently, a systematic review of published cases was performed. ResultsBetween March 2006 and August 2018, 10 of 1974 (0.5%) meningitis patients were diagnosed with vertebral osteomyelitis. The median age was 70 years (interquartile range (IQR) 54–74 years); six (60%) were male and four (40%) were female. The median time between diagnosis of bacterial meningitis and vertebral osteomyelitis was 6 days (IQR 1–13 days). The most common presenting symptoms were back or neck pain, occurring in seven patients (70%); one patient presented with neurological deficits due to cauda equina compression. Streptococcus pneumoniae was the causative pathogen in five patients and Staphylococcus aureus in three. The literature review identified 32 additional cases, showing a similar distribution by age, sex, and pathogen. Seven (18%) of 40 patients from the series presented here and those reported in the literature died. ConclusionsConcomitant vertebral osteomyelitis is rare in community-acquired bacterial meningitis patients. Persisting back pain is a clue to the diagnosis and should prompt magnetic resonance imaging of the spine, because prolonged antibiotic treatment or surgical treatment may be indicated.