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Nocardia Asteroides Meningitis

A Case Successfully Treated with Large Doses of Sulfadiazine and Urea

Robert B. King, William L. Stoops, John Fitzgibbons and Paul Bunn

, 21 different therapeutic regimens were prescribed, including antimeningococcic serum, various sulfonamides, penicillin, streptomycin, tetracycline, chloramphenicol, isoniazid, cortisone, oleandomycin, nystatin, vancomycin, novobiocin, amphetericin and iodides. Jacobson and Cloward's case 8 was the only one reported as a cure; it was treated with sulfadiazine, penicillin and streptomycin (sulfadiazine 6–8 grams daily, and intravenous penicillin 2.5–10 million units daily). The patient was treated for 28 days. A ventricular catheter was used for 12 days to help

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Robert C. Cantu, Marjorie LeMay and Harold A. Wilkinson

'paresis. L. h'anopia. 29th hosp. day coma and death. Dx RMCA. 46 yrs. #10458458 F ABE, mitral valve + + staph. aureus penicillin Intracerebral hemorrhage, R parietal lobe. An. not seen. Sudden coma on 25th day of staph. aureus septicemia. Death 6 days later. 39 yrs. #1075107 M SBE, mitral valve + + staph. aureus penicillin chloromycetin vancomycin RMCA at trifurcation (septic emboli seen in RMCA). Septicemia and SBE secondary to axillary boil. Vigorous antibiotic Tx. On 46th hosp. day sudden coma and death 41 yrs. #118866

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Burton L. Wise, Jacob L. Mathis and Ernest Jawetz

. , 1952, 89: 90–98. 7. Jawetz , E. The forgotten host. Stanford med. Bull. , 1955 , 13 : 84 – 90 . Jawetz , E. The forgotten host. Stanford med. Bull. , 1955, 13: 84–90. 8. Jawetz , E. Polymyxins, Colistin, Bacitracin, Ristocetin and Vancomycin. Pediat. Clins. N. Am. , 1968 , 15 : 85 – 94 . Jawetz , E. Polymyxins, Colistin, Bacitracin, Ristocetin and Vancomycin. Pediat. Clins. N. Am. , 1968, 15: 85–94. 9. Nunn , S. L. , and Wellman , W. E. Pseudomonas meningitis

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Paul Schultz and Norman E. Leeds

temporal horn forming a loculated cyst was fenestrated, leading to good control of the hydrocephalus. This patient had been given two intrathecal administrations of polymyxin B prior to the first ventriculogram and multiple intraventricular instillations of vancomycin through an indwelling left lateral ventriculostomy between the first and second ventriculograms. She received no intrathecal or intraventricular medications between the second and third ventriculograms. In Cases 3, 4, and 7, there were multiple webs in both lateral ventricles in ventriculograms done prior

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Albert V. Messina, Laurence J. Guido and Arie L. Liebeskind

-blush”) of the lesion with central lucency. This subsequently proved to be the abscess cavity. Operation . Surgical exploration of the posterior fossa disclosed a small, brownish discolored mass 2 mm caudal to the facial colliculus on the left side, from which was aspirated approximately 1.5 cc of pus. Immediate frozen section showed necrotic debris with multiple polymorphonuclear cells. Cultures grew Staphylococcus epidermidis sensitive to Keflin (cephalothin) and vancomycin. Anaerobic cultures grew Streptococcus sp. sensitive to chloramphenicol. Postoperative

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

vancomycin in one. Aminoglycosides were used as additional therapy in six patients. Thirteen patients received intrathecal therapy, 11 with bacitracin, and one each with methicillin and cephalothin. The indications for use of intrathecal therapy were not clear from chart review but seemed to relate to the desire of individual physicians to be certain that bactericidal levels were achieved in CSF. While antibiotic levels in the CSF were not routinely assayed, they were measured in the single patient treated with vancomycin. This 7-year-old child with a shunt infection

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. DeVivo William S. Coxe August 1979 51 2 237 239 10.3171/jns.1979.51.2.0237 Posttraumatic meningitis due to ampicillin-resistant Hemophilus influenzae Charles S. Bryan Floyd E. Jernigan August 1979 51 2 240 241 10.3171/jns.1979.51.2.0240 Enlarging histoplasmomas following treatment of meningitis due to Histoplasma capsulatum Maria D. Allo Joseph Silva Jr. Carol A. Kauffman Robert E. Dicks III August 1979 51 2 242 244 10.3171/jns.1979.51.2.0242 Vancomycin treatment of cerebrospinal fluid shunt infections

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Ernest B. Visconti and Georges Peter

S uccessful therapy of cerebrospinal fluid (CSF) shunt infections usually results from removal of the shunt, in conjunction with parenteral antibiotic treatment. 1, 2 However, in some cases infection may persist after shunt removal, and the choice of an effective antimicrobial drug becomes the critical determinant of the clinical outcome. In this report, two such patients with Staphylococcus epidermidis infections in whom vancomycin was effective are described. Use of vancomycin was necessitated by the failure of chloramphenicol in one case and by the

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Neurosurgical Forum: Letters to the Editor To The Editor Robert G. R. Lang , M.D. Robert A. Moody , M.D. Chicago, Illinois 876 877 Drs. Visconti and Peter have reported that vancomycin was successfully used to eradicate two shunt infections that failed to respond to shunt removal (Visconti EB, Peter G: Vancomycin treatment of cerebrospinal fluid shunt infections. Report of two cases. J Neurosurg 51: 245–246, August, 1979). We feel that while vancomycin was indicated according to the

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Gerald R. Greene, Catherine Mc Ninch and Eldon L. Foltz

with 56% neutrophils, 7% band forms, and 28% lymphocytes; and normal urinalysis. Examination of the CSF from the shunt demonstrated one lymphocyte/cu mm, a protein content of 44 mg/dl, a glucose level of 80 mg/dl, and a chloride level of 123 mEq/liter. Cultures of this CSF grew Micrococcus sedentarius , resistant to methicillin but sensitive to cephalothin, erythromycin, kanamycin, tetracycline, chloramphenicol, and vancomycin. Blood cultures were sterile. Therapy was initiated with intravenous vancomycin, 40 mg/kg daily. Audiometric studies became abnormal at 7