Tissue homogenization was followed by subculturing on chocolate II agar and incubation in aerobic and anaerobic blood culture bottles which were incubated for one and two weeks, respectively.

16S-ITS-23S ribosomal DNA (rDNA) was performed on the homogenized tissue.

Visualisation of the PCR amplified DNA fragment of the correct length (4500 base pairs) was performed by using a gel electrophoresis and followed by sequencing using nanopore sequencing technology.

Data analysis for identification was performed using a bioinformatics platform and an in-house developed database.

Aerobic and anaerobic cultures from the deep samples remained negative.

By performing 16S-ITS-23S rDNA sequencing Helicobacter cinaedi was identified in both samples.

H. cinaedi is a Gram-negative, spiral-shaped bacterium that has a strong ability to enter the bloodstream through translocation from the intestine and, in rare cases, cause secondary infections such as arthritis or cellulitis.

This microorganism is resistant to quinolones and is generally susceptible to carbapenems, tetracyclines and aminoglycosides.

Treatment with minocycline 2x100 mg orally was initiated.

A few weeks later, the treatment was switched to doxycycline 2x100 mg due to gastrointestinal side effects associated with minocycline.

A treatment duration of three months was chosen since screw fixation was performed in an infected region and foreign material remained in situ.

The patient made a positive recovery and currently shows no signs of pain or infection.

 

This case also highlights the importance of recognizing H. cinaedi as a possible cause of spondylodiscitis.