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Masanori Sato, Noriko Kubota, Yoshihiko Katsuyama, Yota Suzuki, Yosuke Miyairi, Kisei Minami and Masashi Kasai

M ycoplasma hominis is a small prokaryotic organism belonging to the genus Mycoplasma . This organism lacks a cell wall, rendering it undetectable by Gram staining and making it resistant to beta-lactam antibiotics. Unlike other Mycoplasma species, M. hominis can grow on blood agar and chocolate agar plates; however, such growth is very slow and special techniques are required to identify this organism. Thus, it is very difficult to diagnose infections caused by this pathogen. 4 M. hominis most commonly colonizes the urogenital tracts of sexually active

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Charles S. Bryan and Floyd E. Jernigan

A ppropriate initial antibiotic therapy of life-threatening infections, when no pathogen is demonstrated by Gram-stained smears or other studies, depends upon knowledge of the pathogens most likely to be encountered. There have been few tabulations of the pathogens encountered in posttraumatic meningitis. Hand and Sanford 4 reviewed the findings in 16 patients encountered between 1958 and 1970, and concluded that pneumococcus was the usual infecting agent. They suggested that, unless Gram-stained smears demonstrate a different etiology, therapy should be

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Rogier P. Schade, Janke Schinkel, Freek W. C. Roelandse, Ronald B. Geskus, Leo G. Visser, Marc C. van Dijk, Joan H. C. Voormolen, Hans van Pelt and Ed J. Kuijper

. We evaluated a cohort of 230 patients who had external drains in whom daily CSF samples were obtained. These samples were evaluated using Gram stain and microbiological culture and analyzed for protein and glucose concentrations and leukocyte count. The ED-BM was defined based on positive culture results in combination with clinical symptoms. External drainage–related bacterial meningitis developed in 22 patients (9.6%) in this cohort. We examined the predictive and diagnostic value of the CSF analysis and Gram stain for ED-BM. In a transversal analysis, the

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Melvin P. Weinstein, F. Marc LaForce, Richard J. Mangi and Richard Quintiliani

ml) 52 ± 5 20 ± 7 46 ± 10 <0.005  NS <0.05 white cell count (cells/cu mm) 272 ± 186 2210 ± 1009 2680 ± 690 <0.001 <0.001  NS granulocytes (%) 54 ± 11 74 ± 9 89 ± 4  NS <0.02  NS positive Gram stain 5/7 8/9 5/6  NS  NS  NS * NPCM = non-pneumococcal Gram-positive coccal meningitis. Group 1 = patients with shunt infections (15); Group 2 = patients with non-shunt, postneurosurgical infections (15); Group 3 = patients with no prior neurosurgical procedure (8). NS = not significant

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William B. Lo, Mitul Patel, Guirish A. Solanki and Anthony Richard Walsh

results revealed a hemoglobin level of 14.9 g/dl and a WBC count of 7.9 × 10 3 /μl. The C-reactive protein value was 118 mg/dl (normal range < 10 mg/dl). A CT scan of the brain revealed longstanding ventricular dilation, similar to previous imaging. The CSF obtained from a shunt tap was turbid. Microscopy showed a WBC count of 30 cells/mm 3 (a differential count of WBCs was not available) and a red blood cell count of 159 cells/mm 3 . Gram staining showed gram-negative cocci. Empirical intravenous antibiotics (vancomycin, ceftazidine, and gentamicin) were commenced

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Donald Ross, Harold Rosegay and Vincent Pons

oral temperature; the presence of headache, stiff neck, nausea and vomiting, altered mental status, or new focal deficits; identification of a CSF leak; the presence of a surgically implanted foreign body; and the steroid and/or antibiotic regimen. The laboratory data were reviewed to determine the total and differential leukocyte counts in peripheral blood and CSF, the CSF protein and glucose levels, and the results of Gram staining and CSF cultures. All patients received a single prophylactic dose of broad-spectrum antibiotics at the induction of anesthesia. No

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Rohit K. Khanna, Mark L. Rosenblum, Jack P. Rock and Ghaus M. Malik

peritoneal catheter was then connected and tunneled subcutaneously in a similar fashion. The distal catheter was secured to the skin and connected to a ventriculostomy drainage bag. Patients presenting with a VP shunt infection as diagnosed by shunt tap with a positive organism on Gram staining and/or growth on culture had their distal peritoneal catheter pulled a few inches prior to its entry into the peritoneum at the bedside. The distal catheter was then connected to a ventriculostomy drainage bag. This VP-converted long-tunnel ventriculostomy was then revised either

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Julia Champey, Clément Mourey, Gilles Francony, Patricia Pavese, Emmanuel Gay, Laurent Gergele, Romain Manet, Lionel Velly, Nicolas Bruder and Jean-François Payen

by an independent investigator at each site to define EVD-related CSF infections according to the criteria of Lozier et al. 18 An expert in infection control (P.P.) reviewed cases of VRIs to affirm the conclusions. Suspected and confirmed CSF infections were categorized according to Lozier’s criteria: 1) contamination indicated by an isolated positive CSF culture and/or positive Gram stain with normal CSF cell counts and biochemistry; 2) colonization indicated by multiple positive CSF cultures and/or positive Gram stains with normal CSF cell counts and lack of

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Wesley J. Whitson, Perry A. Ball, S. Scott Lollis, Jason D. Balkman and David F. Bauer

M ycoplasma hominis is a rare complication of neurosurgical procedures. The organism lacks a cell wall and instead has a 3-layer sterol membrane, so it does not appear on Gram stain. 13 To culture M. hominis , specialized media containing animal serum are needed. 14 Polymerase chain reaction (PCR) may be the most sensitive method for diagnosis, but it is not routinely performed. 13 For these reasons, diagnosis is often delayed. Because it is an atypical bacterium, M. hominis does not respond to common empirical antibiotics, which act on cell wall

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David I. Sandberg, J. Gordon McComb and Mark D. Krieger

first intracranial operation, with the objective of achieving multiple fenestrations into adjacent cisternal CSF spaces. At the time of surgery, fluid was obtained from the arachnoid cyst for analysis of protein, glucose, sodium, potassium, chloride, osmolality, cell count, Gram stain, and culture. In almost all cases, the fluid was obtained prior to opening the dura mater by inserting a 25-gauge butterfly needle through the dura into the adjacent cyst and aspirating fluid from it. Data were collected retrospectively after approval was obtained from the Committee on