Metronidazole-induced encephalopathy in a patient with pyogenic spondylitis: a case report

Anaerobic Spondylodiscitis caused by Parvimonas Micra in a Rheumatoid Arthritis Patient: Case Report and Review of the Literature

We report the rare case of Parvimonas micra bacteraemia and secondary spondylodiscitis probably triggered by tooth injury in a rheumatoid arthritis patient. Anaerobic bacteria associated spondylodiscitis may evade diagnosis due to atypical clinical presentation usually lacking fever, and the difficulties related to microbiological characterisation of the pathogen. Even though anaerobic spinal infections may constitute <3% of the total, clinical suspicion should remain high, especially in the case of positive history for pre-existing oral cavity or gastrointestinal/gynaecological tract infections.

A potential new role for ASL perfusion imaging: Diagnosis of metronidazole induced encephalopathy - Two companion cases

Metronidazole induced encephalopathy (MIE) is a rare condition due to prolonged high dose administration of metronidazole. MIE with corresponding increased perfusion on MRI arterial spin labeling (ASL) of the involved regions of the brain appears not to have been reported in the literature to date. We present two such cases, a 59-year-old male with recurrent C difficile colitis with classic MR imaging characteristics of MIE, and a companion case of a 65-year-old female with gangrenous cholecystitis also presumed to have MIE. Despite aggressive medical management, both patients expired. Our cases demonstrate a correlation with ASL hyperperfusion to affected brain regions thought to be due to edema or inflammation. Perfusion imaging may play a role in diagnosis of MIE.

Neurological and Psychiatric Adverse Effects of Antimicrobials

Antimicrobials are a widely used class of medications, but several of them are associated with neurological and psychiatric side effects. The exact incidence of neurotoxicity with anti-infectives is unknown, although it is estimated to be < 1%. Neurotoxicity occurs with all classes of antimicrobials, such as antibiotics, antimycobacterials, antivirals, antifungals and antiretrovirals, with side effects ranging from headaches, anxiety and depression to confusion, delirium, psychosis, mania and seizures, among others. It is important to consider these possible side effects to prevent misdiagnosis or delayed treatment as drug withdrawal can be associated with reversibility in most cases. This article highlights the different neurotoxic effects of a range of antimicrobials, discusses proposed mechanisms of onset and offers general management recommendations. The effects of antibiotics on the gut microbiome and how they may ultimately affect cognition is also briefly examined.