Neurosurgical forum Letters to the editor Spinal Epidural Abscess due to Salmonella Group C Monophasic 1,5 To THE EDITOR: Spinal epidural abscess complicates 4% to 40% of cases of pyogenic vertebral osteomyeli- tisJ While there has been a change in the variety of bacteria responsible for the condition, Staphylococcus aureus still remains the most commonly detected path- ogen. 5 Spinal epidural abscess due to salmonella is rare and has been reported only in isolated cases.2 Salmo- nella typhi is the organism from this group most com- monly implicated, with infection usually occurring in the recovery phase after a variable time period. 2 The importance of the Salmonella C I group in bone infec- tions has been emphasized,4 with a significant correla- tion found between abnormal hemoglobinopathies (especially sickle-cell trait) and osteomyelitis due to SalmonelleaeJ"3'4 Spinal epidural abscesses cause a neurosurgical emergency in which administration of appropriate antibiotics is as important as early surgical decompression. Usually, death results if the abscess is not drained. To emphasize the importance of appro- priate antibiotic therapy, we report a case of cervical epidural and retropharyngeal abscess due to a rare Salmonella serotype, C I (monophasic 1,5). This 35-year-old laborer was well until November FIG. 1. X-ray film of the cervical spine showingreduction of the disc space between C-6 and C-7 and a retropharyngeal abscess (arrows). 1983, when, 2 weeks after a bout of diarrhea, he began having a persistent high fever with chills. One week later he developed neck pain and stiffness. His symp- toms worsened rapidly over the next 2 to 3 days, and he became quadriplegic with retention of urine and feces. Neurological examination at admission revealed a spastic quadriplegia. Except for the triceps reflexes, all tendon reflexes were exaggerated. There was a bilat- eral extensor plantar response. All sensation was lost below the C-3 segment. Marked spinal tenderness was elicited over the C5-7 vertebrae. There was no evidence of systemic infection or septic focus elsewhere in the body. Cervical spine x-ray films revealed a loss of disc space height between C-6 and C-7, destruction of the adjacent vertebrae, and the presence of a retropharyngeal mass (Fig. 1). Repeated cultures from throat, blood, and urine were sterile. The hemogram, urinalysis, metabolic pa- rameters, and chest x-ray films were normal. Testing for sickling was negative, and no abnormal hemoglobin was detected on electrophoresis. Pus aspirated from the retropharyngeal space revealed a pure growth of Sal- monella 6,7 monophasic 1,5 that was sensitive to chlor- amphenicol. The patient's antibody was typed using standard bacterial antigen, and the species of the in- fecting organism was confirmed. Repeated aspiration of pus and institution of chloramphenicol therapy sup- plemented by traction led to an excellent neurological recovery. Interesting aspects of this case included the isolation of the Salmonella serotype Group C I (monophasic 1,5) from the aspirated pus. Before our case, this serotype had not been reported in India (SN Saxena, personal communication, 1984). Also, our patient had no ab- normal hemoglobinopathy or any disturbance in im- munological status. Even though his treatment was started l0 days after onset, a good neurological recovery ensued following drainage of pus, institution of chlor- amphenicol therapy, and immobilization of the cervical spine. At discharge, the patient could walk without support, and he had regained full sensory function and sphincter control. Weakness of the elbow extensors and small muscles of the hands persisted, however. DR. P. V. S. RANA DR. D. RAGHUNATH DR. K. UNNI PARAKKAL DR. S. BISWAS DR. S. PRAKASH NeurologyCenter, Command Hospital Pune, India 942 J. Neurosurg. / Volume 62 / June, 1985 Unauthenticated | Downloaded 10/07/22 03:29 PM UTC