Antibiotics | New Pathogen for Disc Infections: Insights from Clinical Cases and Literature Review

This study reports a rare disc infection case caused by Veillonella parvula and systematically reviews existing literature, summarizing the pathogen's clinical characteristics and treatment strategies. The findings provide critical references for clinicians, particularly in accurately identifying this pathogen under challenging blood culture conditions.

 

Literature Review
This article titled 'Veillonella parvula as a Causative Agent of Discitis: Insights from a Clinical Case and Literature Overview' published in Antibiotics synthesizes reported cases of Veillonella spp.-induced disc infections while presenting a clinical case of L3-L5 disc infection in an 80-year-old male. The study analyzes antimicrobial susceptibility patterns and treatment strategies for this pathogen.

Background Knowledge
Veillonella species are Gram-negative, non-motile, non-fermenting strictly anaerobic cocci typically existing as commensal organisms in oral, respiratory, urogenital, and gastrointestinal tracts. Though rare pathogens, they can cause dental infections, discitis, endocarditis, hepatopulmonary infections, and bacteremia. Due to specific growth requirements, blood culture detection rates are low, making molecular diagnostics like 16S rDNA sequencing essential complementary tools. Current treatments primarily involve β-lactam antibiotics (e.g., amoxicillin/clavulanate), though drug resistance patterns show heterogeneity. This study reviews 14 reported cases of Veillonella-related disc infections, offering valuable clinical insights.

 

 

Research Methods and Experimentation
The researchers reported an 80-year-old male presenting with neurogenic right plantar pain and reduced mobility. MRI revealed abnormal L3-L5 disc signals without apparent vertebral or soft tissue involvement. Diagnosis combined blood culture with MALDI-TOF MS and 16S rDNA sequencing confirming Veillonella parvula infection. Treatment followed antimicrobial susceptibility testing with amoxicillin/clavulanate, transitioning from intravenous to oral administration over six weeks. A systematic literature review using PubMed database and keywords like 'Veillonella spp.', 'spondylodiscitis' identified 14 additional Veillonella disc infection cases for analysis.

Key Conclusions and Perspectives

• Veillonella-induced discitis is extremely rare, with only 14 documented cases globally, 9 of which were caused by V. parvula.
• Typical presentations include localized pain (lumbosacral/cervical) with average symptom duration of six weeks, sometimes accompanied by fever.
• Antimicrobial susceptibility patterns demonstrate heterogeneity, though β-lactams (amoxicillin/clavulanate) show consistent efficacy through intravenous-to-oral step-down therapy.
• Magnetic resonance imaging (MRI) remains the gold standard for diagnosis, with tissue culture or PCR serving as primary pathogen identification methods.
• Only 64% of cases identified clear risk factors including dental disease, spinal procedures, or gastrointestinal interventions.

Research Significance and Prospects
This work emphasizes the importance of recognizing Veillonella spp. as potential etiological agents in disc infections, particularly when traditional infection sources remain unidentified. Future research should focus on improving clinical microbiology detection methods to enhance anaerobic culture rates, while investigating host-pathogen interactions and resistance mechanisms to support precision medicine approaches.

 

 

Conclusion
This study documents a rare Veillonella parvula discitis case and synthesizes 14 previously reported cases from literature. Due to low detection rates in routine blood cultures, molecular diagnostics and mass spectrometry analysis become critical for identification. β-lactam antibiotics with intravenous-to-oral switch therapy form the treatment backbone. Clinicians should maintain heightened suspicion for this pathogen in patients with dental history or gastrointestinal interventions. Early diagnosis and tailored treatment improve outcomes. Given the rarity of these infections, multi-center studies remain necessary to better define clinical features and optimize therapeutic protocols.

 

Giulio D’Agati, Lorena Mignone, Antonella Bartolone, Luca Pipitò, and Antonio Cascio. Veillonella parvula as a Causative Agent of Discitis: Insights from a Clinical Case and Literature Overview. Antibiotics.