Pyogenic Spondylodiscitis Caused By Streptococcus Agalictiae - A Case Report

Abstract

Introduction: Group B streptococcus (Beta-haemolytic streptococcus, Streptococcus agalactiae) is one of the most frequent cause of sepsis and infectious disease in neonates. However, the disease burden is now shifting towards adults. We report a case of Group B streptococcus spondylodiscitis in an adult female. Case Report: An elderly female with history of carcinoma breast for which she underwent mastectomy 20 years back, developed low back ache of  one month duration. She had elevated ESR and CRP, and MRI was suggestive of spondylodiscitis at D12-L1 level. She underwent biopsy, Culture and sensitivity and posterior fixation. Culture yielded Streptococcus agalactiae. She was further treated with culture specific antibiotics. Discussion: Group B streptococcus commonly colonizes the gastrointestinal and urinary tracts of healthy adults and the genital tract of healthy females. Puerperal women and patients with severe underlying diseases are at higher risk of Streptococcus agalactiae infection. Clinical features are same as spinal infections, with elevated ESR, CRP, total counts and MRI changes. Blood culture is mandatory but may yield false negatives. Open or CT guided biopsy for culture and sensitivity is recommended. Principal of surgery is to remove avascular infected disc tissue. Combination of beta lactam antibiotic and amino glycoside is recommended for 6 weeks. Conclusion: Whatever the patient's immunological status, we recommend that Group B Streptococcus should be considered in the differential diagnosis of infective spondylodiscitis in adults, and invasive diagnostic tests be done.