Chengdu University of Traditional Chinese Medicine’s Third Clinical Medical College, affiliated with the Third Hospital, is located in Chengdu, Sichuan, 611730, People’s Republic of China. This institution hosts the Pidu District Traditional Chinese Medicine Hospital, a facility providing critical healthcare services to the community.
Correspondence regarding research or clinical inquiries should be directed to Xiaoheng Wu at the Pidu District Traditional Chinese Medicine Hospital, Chengdu, Sichuan, 611730, People’s Republic of China, via email at [email protected].
Abstract: Moraxella catarrhalis (MC) is an aerobic Gram-negative cocci known primarily for causing respiratory tract infections in humans. It operates as an opportunistic pathogen, with infections occurring in other body parts being significantly rarer. A particularly challenging case is presented involving an elderly female patient who had a complex medical history including hypertension, type 2 diabetes, coronary heart disease, and osteoporosis. Following coronary angiography and lumbar spine surgery due to lower back and left lower limb pain, the patient experienced persistent pus discharge from her lumbar spine surgical wound. This condition did not respond to conventional anti-infection treatments, necessitating her transfer to our specialized hospital for further management. Upon examination, imaging through Direct Radiography (DR) revealed gas accumulation and bone curling affecting the lumbar vertebrae’s 4–5 intervertebral space, muscle layer, and fascia layer. Subsequent culture analysis of the wound pus confirmed the presence of MC, thus diagnosing a postoperative lumbar spine infection. Treatment protocols involved the administration of targeted antibiotics, lesion clearance, thorough spinal exploration, and autologous iliac bone transplantation for fusion. Comprehensive care also included the regulation of glucose levels and hypertension, anticoagulation therapy, as well as the application of the traditional Chinese herbal remedy, Duhuo Jisheng Decoction, aimed at enhancing blood circulation and alleviating blood stasis. Thanks to this holistic treatment strategy, the patient achieved a complete recovery and was eventually discharged. Notably, this case represents the first documented instance of a post-lumbar spinal fixation and fusion Moraxella catarrhalis infection in Sichuan Province, China, highlighting the necessity for clinicians to consider MC’s potential colonization site and infection mechanisms beyond its traditionally recognized respiratory tract role.
Introduction
Moraxella catarrhalis (MC), also known as Branhamella catarrhalis, typically resides in the upper respiratory tract of humans. Once presumed to be a harmless component of normal flora, it has since emerged as a noteworthy pathogen associated with a range of infections, including upper respiratory tract infections, acute otitis media, maxillary sinusitis, and lower respiratory infections. The role of MC in exacerbating respiratory conditions, particularly in elderly individuals suffering from chronic obstructive pulmonary disease, remains a key area of concern.
This report presents a rare case of an MC infection occurring after lumbar spinal fixation and fusion surgery, marking a significant first in the region of Sichuan, China. The peculiarities of this case contribute to the growing body of knowledge regarding less common infections associated with this pathogen.
Case Report
Notably, upon examination, a surgical wound approximately 12 cm long was detected on the patient’s waist, extending into the fascia layer, with a concerning white flocculent purulent discharge present. The patient’s vital signs revealed a body temperature of 36.1°C, pulse rate at 95 beats per minute, blood pressure documented at 137/68 mmHg, and a random blood sugar level of 7.7 mmol/L. Direct Radiography (DR) results illustrated various abnormalities in the lumbar spine, including slight scoliosis, noted degenerative changes in the vertebral bodies, pneumatosis identified within the 4–5 intervertebral space, and notable alterations in the muscle and fascial layers. Additionally, frizzy bone characteristics were evident in the imaging, indicating a probable intervertebral space infection.
The laboratory tests indicated the patient’s lymphocyte count was notably low at 0.67×10^9/L, matched with a minimal eosinophil count of 0.01×10^9/L, and a high neutrophil ratio of 75.6%. Further can be assessed with red blood cell levels at 3.29×10^12/L, hemoglobin concentration around 100 g/L, and hematocrit levels of 31.8%. Other significant lab findings included elevated high-sensitivity C-reactive protein at 122.88 mg/L, along with abnormal electrolyte results reflecting potassium at 3.25 mmol/L and magnesium at 0.72 mmol/L.
To confirm the diagnosis, pus samples from the wound were collected and sent to the microbiology laboratory for immediate analysis. Gram staining revealed the presence of Gram-negative diplococci characteristically shaped like coffee beans. Following incubation on a blood agar plate at 35°C for 18–24 hours, grayish-white, non-hemolytic colonies were identified. Subsequent diagnostic testing confirmed the presence of MC utilizing a fully automated microbiological analysis system, further affirming the clinical findings.
To optimally address the multifaceted issues presented by the patient, a tailored, comprehensive treatment plan was put into place aimed at enhancing nutritional intake alongside clinical management of comorbid conditions. Beneficial adjunct therapy included administering Duhuo Jisheng Decoction for its known properties in promoting circulation and addressing blood stasis.
Following thorough and proactive treatment measures, including invasive interventions for infection focus removal, there was marked improvement in the patient’s condition leading to a significant reduction in pain. Imaging after one month showed shrinking of the infection focus, leading to the patient’s eventual discharge after satisfactory reassessment of clinical indicators.
Discussion
Infections post-lumbar spinal fixation represent a significant challenge in orthopedic surgery, with the incidence rate estimated between 9% and 12%. Critical insight has been provided by previous studies indicating that complications arising from such infections greatly inflate overall medical costs. Procedures aimed at the lumbar region especially require sophisticated management strategies due to the inherent risks associated with retained fixation devices which are crucial for structural integrity post-surgery.
Recent advancements in surgical procedures necessitate a heightened awareness of infection risks among polymicrobial agents, including MC, as it broadens the scope beyond classical respiratory infections. Proactive measures should encompass meticulous adherence to standardized surgical protocols and vigilant monitoring to minimize infectious complications throughout all phases of care.
Emerging data indicate rising resistance rates among MC strains across various regions, largely attributed to β-lactamase production. These clinical developments must be recognized and integrated into contemporary treatment regimens emphasizing susceptibility testing, particularly as existing resistance may complicate standard antibiotic treatment strategies.
Conclusion
In summation, lumbar space infection attributable to Moraxella catarrhalis remains relatively uncommon with ambiguous clinical presentations. However, microbiological culture and targeted antibiotic treatment proved pivotal in successfully resolving the patient’s infection. Rigorous clinical vigilance is warranted in recognizing infections stemming from unique pathogens alongside thorough evaluations tailored to patient symptoms and clinical findings.
Abbreviation
MC, Moraxella catarrhalis; OM, Otitis media; DR, Direct Radiography; NCCLS, The National Committee for Clinical Laboratory Standards.
Ethics Approval
No images or data that could identify patients are included, thus ethical approval was not required. However, the patient’s informed consent for publication has been obtained.
Acknowledgments
We extend our gratitude to all study participants.
Funding
No funding sources to disclose.
Disclosure
No conflicts of interest arise from this manuscript, which has been approved for publication by all authors involved.
The Curious Case of Moraxella catarrhalis: Not Just for Sneezes!
Picture this: you’ve just undergone lumbar spine surgery—well, actually that sounds a bit too much like a logistical nightmare than a lively day out, doesn’t it? From the bustling Chengdu University of Traditional Chinese Medicine to the patient drama unfolding within its walls, our story involves an elderly lady, some life’s little health hurdles, and a sneaky microorganism you probably didn’t know had such a knack for bad behavior. Yes, let’s talk about Moraxella catarrhalis—the respiratory tract’s not-so-welcome yet surprisingly versatile Alex Reed.
Meet the Culprit: Moraxella catarrhalis
First off, what on earth is Moraxella catarrhalis? Well, it’s like that friend who’s always there when you don’t want them to be. This Gram-negative cocci typically hangs around in our upper respiratory tract, minding its own business, but can decide to stir up trouble when it gets the chance! While most of us know it as a frequent flyer in cases of ear infections and bronchitis, it has now branched out into the rather niche category of lumbar spine infections post-surgery. Now that’s one ambitious microbe.
Our protagonist in this medical saga is an elderly female patient grappling with a surprising cocktail of conditions: hypertension, type 2 diabetes, coronary heart disease, and osteoporosis. One would think that juggling all these issues is enough excitement, but oh no, life had a twisted plotline in store. Post-surgery, she developed a rather unpleasant pus-filled situation at her surgery site. Talk about a real bout of ‘picking the wrong kind of infection’!
The Diagnosis: Pus, Pain, and Drama
On examination, you’d find a 12 cm long wound at her waist, which, judging by the description, sounds like it had been through the wars. And then came the imaging results—nothing like a bit of Direct Radiography (DR) to sweeten the deal. It revealed gas accumulation and bone curling in the lumbar region, not exactly your typical spa day diagnostic.
Diagnosed with a postoperative lumbar spine infection courtesy of our sneaky friend, MC, her treatment plan exploded into action. Here’s where medicine meets creativity: antibiotics, a touch of surgery, a dash of Chinese herbal medicine, and a healthy optimization of her metabolic conditions. If only all our lives had such a comprehensive treatment plan, right?
The Not-So-Usual Suspect: Why Here and Now?
Now, one might ponder, why on earth would Moraxella catarrhalis pop up at the scene of a lumbar spine journey? This isn’t a microbe that’s known for playing in the spinal fields. The authors of our thrilling case report, riding on the coattails of this rare infection, noted this as a first for the Sichuan Province. It does lead one to wonder if the little bacterium just fancied a change of scenery—like a microbe’s version of a spontaneous holiday.
The Moral of the Story: Vigilance is Key!
So what do we learn from this rollercoaster of a case? Well, apart from the fact that we should be forever vigilant about our microbial neighbors, it also highlights that we should not overlook potential pathogens that reside in atypical locations. It serves as a friendly reminder (or a stern warning, depending on how you look at it) for medical professionals to remain suspicious of infections beyond where they typically lurk.
Finally, we’ve got to appreciate the patient’s outcome—a full recovery and discharge from the hospital. That’s the sort of satisfying ending we can all get behind! Here’s to your health, creativity in medicine, and trusting your gut when something doesn’t seem quite right. Remember: Not all heroes wear capes, some just wield a culture plate!
Concluding Thoughts
In conclusion, Moraxella catarrhalis isn’t just a casual passenger in respiratory ailments; it’s making big moves in unexpected territories! So next time you hear someone sneeze, take a moment to ponder: what might be happening in their lumbar region? It might just be the kind of story you never expected!
Alis decide to stage a coup in the lumbar spine when it’s usually content to hang out in our noses and throats? This case underscores the importance of recognizing alternative infection pathways for a bacterium traditionally linked to respiratory issues. The increasing occurrences of such atypical infections highlight the need for clinicians to broaden their diagnostic horizons, especially for patients with complex health backgrounds like our elderly protagonist.
The Takeaway: Monitoring and Management
In the world of medicine, where surprises lurk around every corner, vigilance is key. Healthcare providers must maintain awareness of the potential for Moraxella catarrhalis and other polymicrobial agents to initiate infections in unexpected locations, particularly post-surgery. Standard protocols must not only focus on preventing infection but also be flexible enough to adapt to emerging pathogens. This case serves as a clarion call for proactive measures, including meticulous wound management and appropriate antibiotic stewardship, especially given the rising resistance rates among certain strains of MC.
Conclusion: A Call to Action
this curious case of Moraxella catarrhalis as the culprits in a postoperative spinal infection encourages a wider lens in clinical practice. The paramount lesson here? Always consider the unexpected—a seemingly harmless bacterium can defy expectations and contribute to complex clinical scenarios. With a multi-faceted treatment approach, our patient turned the tide on a troublesome infection, shedding light on a lesser-known aspect of a commonly encountered bacterium. So, next time you hear about Moraxella catarrhalis, remember it’s not just a casual acquaintance from respiratory infections; it could be lurking, waiting to surprise us in the most unusual places!
