Veillonella spondylodiscitis in a healthy 76-year-old lady

Veillonella Discitis: A Rare Presentation and Review of Literature

Background

Veillonella is an anaerobic gram-negative coccus found as a commensal organism in the oral, respiratory, gastrointestinal, and genitourinary tract of humans. Rarely, it can cause serious infections by the production of lipopolysaccharide, an endotoxin. Although most Veillonella infections occur in immunocompromised individuals, we herein describe cases of Veillonella discitis, a rare presentation of Veillonella, in immunocompetent patients.

Case Presentation

The first presented case was encountered in a patient admitted at our facility. All patient data were obtained from the hospital's electronic medical record system. Thereafter, a literature search and subsequent review was done on PubMed with the MEDLINE database, using the term "Veillonella discitis," to obtain other reported cases of discitis caused by Veillonella.We found a total of 9 cases of Veillonella discitis in immunocompetent patients, apart from our patient. It was most frequently found in those aged 60 to 70 years, with no particular association with patient sex. Chronic backache was the most reported presenting symptom, the lumbar spine being the most commonly affected area, with a high number of cases occurring in the presence of an inciting event. Ceftriaxone, amoxicillin, and clavulanic acid were the most commonly used drugs, with an average duration of therapy of 6 weeks.

Conclusion

The objective of our study was to highlight the importance of recognizing Veillonella as a potential cause of discitis. We aim to educate medical professionals regarding the presentation of Veillonella discitis, the demographic groups affected, predisposing factors, and the treatment options available.

The first case of Veillonella atypica bacteremia in a patient with renal pelvic tumor

We report the first case of bacteremia caused by Veillonella atypica in a morbid elderly female patient who developed obstructive pyelonephritis. She was treated with ceftriaxone and ureteral stenting; this is the first report of V. atypica infection in humans. Species identification was performed by multiplex PCR and sequencing of rpoB. The strain was susceptible to metronidazole and clindamycin but resistant to benzylpenicillin, ampicillin, ampicillin/sulbactam, and moxifloxacin.

Spondylodiscitis due to anaerobic bacteria Veillonella parvula: Case report and literature review

Background:

While pyogenic spondylodiscitis due to Gram-positive aerobic bacteria and its treatment is well known, spondylodiscitis caused by anaerobic Gram-negative pathogen is rare. In particular, the spondylodiscitis caused by Veillonella species is an absolute rarity. Thus no established management recommendations exist.

Case Description:

A case report of a 79-year-old man with spondylodiscitis caused by Veillonella parvula with intramuscular abscess collection managed conservatively with stand-alone antibiotic therapy without a spinal stabilization procedure. A review of literature of all reported spondylodiscitis caused by Veillonella species was performed. After 3 week-intravenous therapy with the ceftriaxone in combination with the metronidazole followed by 3 weeks per oral therapy with amoxicillin/clavulanate, the complete recovery of the patient with the V. parvula infection was achieved.

Conclusion:

Treatment of the spondylodiscitis caused by Veillonella species should contain a beta-lactam with beta-lactamase inhibitor or third-generation cephalosporine. Six weeks of treatment seem to be sufficient for the complete recovery of the patient.

Epidural abscess and spondylitis caused by Veillonella parvula in a man on hemodialysis

Veillonella species rarely cause serious infections, but the incidence of infection has been increasing among immunocompromised individuals. This case of an epidural abscess and spondylitis caused by Veillonella parvula in a hemodialysis patient illustrates the importance of performing anaerobic blood culture in immunocompromised patients with signs of infection.

Case report: vertebral osteomyelitis secondary to a dental abscess

BACKGROUND

Vertebral osteomyelitis can be attributed to many factors including immunosuppression, diabetes, malignancy, collagen disease, periodontal disease, open fractures, and endoscopic procedures. Anaerobic bacteria, such as Veillonella species, are found in the oral cavity and are rarely implicated in the infection. This report describes vertebral osteomyelitis secondary to a dental abscess with positive Veillonella cultures.

CASE DESCRIPTION

A 76-year-old man presented to the hospital due to back pain with a four-day history of fever and chills. CT scans revealed several abscesses in the lumbar region as well as indications of vertebral osteomyelitis. After a psoas drain, the patient began antibiotics with a combination of ampicillin-sulbactam, metronidazole, and levofloxacin, but due to the patient's penicillin allergy, he was initially desensitized to this antibiotic for a significant period of time. Laminectomies, foraminotomies, and facetectomies were performed, but the infection spread to vertebral levels. The patient was then switched to a combination of vancomycin, metronidazole, and levofloxacin which eliminated the infection. Final laminectomy was performed with posterior segmental instrumentation and arthrodesis. Post-operatively, there were no signs of infection. The patient recovered well and regained mobility. Deeper examination of the patient's medical history revealed a severe tooth abscess immediately before the onset of bacteremia.

CONCLUSION

We believe that a delay in the onset of antibiotic treatment is what led to the initial bacteremia that ultimately took root in the lower lumbar vertebrae. To the best of our ability, we could identify only one other case that linked vertebral osteomyelitis to the oral cavity.

Veillonella parvula spondylodiscitis

OBJECTIVES

Veillonella parvula is an anaerobic Gram-negative coccus rarely involved in bone and joint infections.

PATIENTS AND METHOD

We report the case of a Veillonella parvula vertebral osteomyelitis (VO) in a female patient without any risk factor.

RESULTS

The 35-year-old patient was immunocompetent and presented with Veillonella parvula VO. She was admitted to hospital for inflammatory lower back pain. The discovertebral sample was positive for Veillonella parvula. Literature data on Veillonella VO is scarce. Reported cases usually occurred in immunocompromised patients. Diagnosis delay can be up to four months. Patients are usually afebrile. Outcome with antimicrobial treatment alone is favorable in half of cases. Other patients must undergo surgery.

CONCLUSIONS

Veillonella VO may occur in immunocompetent patients and have a clinical spectrum of mechanical lower back pain.

Lytic lesions: looking lethal but leaving room for a simple cure? A case of Veillonella spinal osteomyelitis

Introduction. Diagnosing clinically significant infection caused by Veillonella species can be a challenge. Veillonella species are usually found in polymicrobial processes and are often regarded as a contaminant. Additionally, they are slow to grow in culture and this can lead to a delay in diagnosis or a missed diagnosis. Veillonella species rarely cause serious infections, but have been found to cause bacteraemia and osteomyelitis.

Case presentation. A 67-year-old man with a history of treated prostate cancer presented with 2 weeks of progressive lower back pain and weakness. He had no signs or symptoms of active infection. He was found to have multiple lytic lesions in his lumbar spine that were initially suspected to be secondary to metastatic cancer. However, tissue and blood cultures were ultimately consistent with infection by Veillonella species.

Conclusion. This case report highlights the fact that uncommon illnesses can often present like common disease processes. Because of the radiological appearance of the patient’s lesions and his lack of infectious symptoms, a diagnosis of metastatic cancer was initially thought to be likely. Relying on the pathology and culture data, and waiting on the initiation of antimicrobials until the diagnosis was accurately established, were important factors in diagnosing and treating this infection. Veillonella species can be true pathogens when found in isolation and associated with bacteraemia. Additionally, they can cause an indolent infection that can lead to osteomyelitis. Failure to accurately diagnose this infection in a timely manner would have led to ongoing debility and diagnostic uncertainty for this patient.

Osteomyelitis caused by Veillonella species: Case report and review of the literature

Previously, Veillonella species had been considered as nonpathogenic and rarely caused serious infections. We report a case of 25-year-old man with osteomyelitis caused by Veillonella species. He was admitted to the hospital due to an open fracture to the left radial bone caused by industrial washing machine accident, and emergency surgery was performed. However, wound infections occurred one week after the operation. Although Acinetobacter baumannii and Serratia marcescens were cultured from the pus, obligate anaerobic bacteria were not detected at that point. Debridement was repeated and antibiotics were changed according to the result of bacterial culture and drug sensitivity. Despite this, the infection was poorly controlled. On the 5th debridement, granulomatous bone tissues on pseudarthrosis were found for the first time at the infection site. Although no bacteria was detected with aerobic culture, anaerobic incubation revealed Gram-negative cocci which was later identified as Veillonella species by 16S rRNA gene sequence analysis. His condition improved without any additional debridement after adding effective antibiotics against Veillonella species. It is well known that prolonged infection with aerobes consumes oxygen in the infection site and leads the environment to more favorable conditions for anaerobic bacteria, thus we speculated that prolonged infection with bacteria such as S. marcescens induced the favorable environment for Veillonella species. Physicians should realize the importance of anaerobic culture method in routine practice, especially in complicated cases such as the present case. In this article, we reviewed case reports of Veillonella infection and summarized the clinical features of this organism.

Non-vertebral Veillonella species septicemia and osteomyelitis in a patient with diabetes: a case report and review of the literature

INTRODUCTION

Veillonella is a nonfermentative, strictly anaerobic, Gram-negative coccus that forms part of the human gastrointestinal tract, mouth and vaginal flora. Like other anaerobic infection, Veillonella species usually are involved in polymicrobial processes, which make it difficult to determine their pathogenic role. Isolation of a clinically significant Veillonella species is rare and V. parvula is the most common one reported to cause infection in humans. The most frequently reported infection caused by V. parvula is osteomyelitis, almost always in association with bacteremia.

CASE PRESENTATION

Here, we describe a rare case of nonvertebral osteomyelitis and septicemia caused by Veillonella species in a 49-year-old Saudi man with diabetes. Initial treatment with ciprofloxacin was associated with treatment failure and poor response. Identification of the organism was essential for the selection of appropriate treatment. There have been only seven previous reports of Veillonella vertebral osteomyelitis and one report of V. parvula foot osteomyelitis with sepsis in the literature. This is the second case of Veillonella nonvertebral osteomyelitis associated with septicemia reported to date.

CONCLUSIONS

Veillonella species should be considered a true pathogen in diabetic patients with osteomyelitis and those with underlying immune suppression, particularly if the organism is isolated from blood. The isolation of those obligate anaerobes from blood may signal the presence of severe underlying disease and the probable need for timely surgical intervention.

Epidural abscess caused by Veillonella parvula: Case report and review of the literature

Veillonella parvula, an anaerobic, Gram-negative coccus is part of the normal flora of the oral, gastrointestinal, respiratory, and genitourinary tracts in humans and animals. We herein present a case of epidural abscess caused by V. parvula in a 68-year-old man with sinus squamous cell carcinoma who presented with a 3-week history of low back pain. Blood and pus cultures were positive for Veillonella spp. After sequencing of the 16S ribosomal DNA, the pathogen was identified as V. parvula. Surgical debridement was performed following which the patient received intravenous administration of amoxicillin/clavulanate. To our knowledge, there are only seven reported cases of spinal infection caused by Veillonella spp. and these are reviewed here.