Abstrakt
I read with interest the original report "Vertebral osteomyelitis in bacterial meningitis patients" (Sheybani et al., 2021). The authors pointed out the possible coexistence of acute bacterial meningitis (ABM) and vertebral osteomyelitis (VO), or infective endocarditis, and the need for longer duration of antimicrobial treatment in such cases.
That is correct. However, the hypothesis that VO is a complication of ABM is rather incorrect.
VO is caused in most cases by hematogenous dissemination of infection, rarely by contiguous spread from adjacent soft tissue infection, retroperitoneum or pelvis. Infectious inflammation of the vertebral body, disc and facet joint develops for weeks to months before it manifests clinically.
Leptomeningeal infection develops only a few hours to days until the onset of clinical symptoms. Thus, in terms of time, meningitis is very unlikely to be the cause of osteomyelitis.
The fact that osteomyelitis was diagnosed a few days after the diagnosis of meningitis does not confirm the time scenario meningitis first and then osteomyelitis. The probable sequence in most cases is at first spondylodiscitis that induces meningitis, initially spinal followed by cranial meninges involvement.
The authors also hypothesize that a parameningeal infectious focus may elicit an inflammatory response of leptomeninges. That is true but such infectious foci (abscesses) mostly result from local extension of infection from vertebra or disc.