Ganga Ram hospital reports world’s first case of B. coli in spine,bones

The bug infected his vertebrae,resulting in compression of the spinal cord — a condition known as myelopathy,which weakened all four of his limbs simultaneously.

Doctors from Sir Ganga Ram hospital (SGRH),where the patient’s histopathology sample was analysed,and Paras hospital in Gurgaon,where the patient first reported,have published the case in the March issue of the Journal of Neurosurgery.

Dr Shashi Dhawan,consultant,histopathology at SRGH and the corresponding author of the article,said: “B. coli is a rare parasite that is hosted primarily in pigs. Its infection in humans is rare,but if at all there are cases of human infection,we see intestinal involvements,resulting in diarrhoea and dysentery. But in this case,it infected the spine causing such grave symptoms.”

Neurosurgeons first thought the patient’s symptoms could at best be attributed to spinal TB. “The patient had high grade fever,and low haemoglobin count. An MRI showed a pus-filled cavity between the C3-4 vertebrae in his spine. These were indicative of spinal TB,so we started him on anti-tuberculosis treatment,” Dr VS Mehta,chief of neurosurgery at Paras hospital,and former HoD of the discipline at AIIMS,said.

Doctors also had to perform a surgery to remove a disc in between the infected vertebrae in his spine — a procedure known as discectomy,to drain out the pus. A portion of the patient’s iliac bone — the largest bone in his pelvis — had to be grafted in this operated area. The pus that had collected in the spine was then sent for histopathological evaluation to confirm TB.

Dr Dhawan from Ganga Ram hospital said,“In 99 per cent cases in India,any infection in the spinal cord turns out to be tuberculosis. But as we found,after evaluating all the published medical literature,B. coli in the spine has never been reported before.”

Dr Mehta said the doctors treating the patient were “surprised” after the histopathology report. “After the report confirmed B.coli infection,we started him on two basic drugs — metronidazole and tetracyclines. “The patient started responding soon after,and he was absolutely fine at the time of discharge,” he said.

WHAT IS B.COLI

The Balantidium coli (B. coli) is a rare parasite that is hosted primarily in pigs. Human infections are rare and it traditionally targets the intestine causing bouts of diarrhoea

THE CASE

The bug infected his vertebrae,resulting in compression of the spine – a condition known as myelopathy,which weakened all his limbs simultaneously.

THE TREATMENT

n Surgery performed to remove a disc in between the infected vertebrae

n Histopathology at SRGH reveals B. coli,instead of TB of spine.

n Patient started on two drugs — metronidazole and tetracyclines