Streptococcus pneumoniae spinal infection in Nottingham, United Kingdom: Not a rare event

Pneumonia and meningitis are the most frequent manifestations of Streptococ cus pneumoniae infection. Spinal infection is considered to be a rarity. Be tween 1985 and 1997, 8 patients with spinal infection (vertebral osteomyeli tis, 3; spinal epidural abscess, 1; both, 4) due to S. pneumoniae were seen at University Hospital (Nottingham, U.K.). Predisposing factors for pneumo coccal infection were documented for five patients and included diabetes me llitus, alcoholism, and corticosteroid therapy. One patient presented with concomitant meningitis and endocarditis. Clinical features of note were pro longed symptoms and a lack of febrile response. S, pneumoniae was isolated from the blood of five patients. Magnetic resonance imaging was used to loc alize the spinal infection in five patients. Two cases were managed medical ly. Three patients died after a protracted illness. A literature search rev ealed 20 other cases of spinal infections due to S. pneumoniae. The salient features of the cases are summarized.