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Persistent CSF leucocytosis associated with intrathecal gentamycin
1Nuffield Department of Neurosurgery, Radcliffe Infirmary, Oxford, United Kingdom.
Abstract:
A case where the administration of intrathecal gentamycin, used to treat a ventriculitis consequent upon a ventriculoperitoneal shunt infection, with a persistent elevation of the CSF leucocyte count is described. In a situation where the number of white cells in the CSF is taken to indicate resolution of infection, it is important to recognise that apparent failure of resolution of infection may be due to the gentamycin itself and not persistent infection.
Insights
Intrathecal gentamycin can cause elevated cerebrospinal fluid (CSF) white blood cell counts, mimicking persistent infection. This highlights the need to consider drug effects when assessing treatment response in ventriculitis.
Area of Science:
- Neuroscience
- Infectious Diseases
- Pharmacology
Background:
- Ventriculitis, an infection of the brain's ventricles, often arises from ventriculoperitoneal shunt complications.
- Intrathecal antibiotic administration is a common treatment for shunt-related ventriculitis.
- Cerebrospinal fluid (CSF) leucocyte count is a key indicator for infection resolution.
Observation:
- A case of ventriculitis treated with intrathecal gentamycin presented with persistently elevated CSF leucocyte counts.
- This elevation was initially interpreted as a sign of unresolved infection.
Findings:
- The persistent elevation in CSF leucocytes was attributed to the effects of gentamycin itself.
- Gentamycin administration can independently increase CSF white blood cell counts.
Implications:
- Relying solely on CSF leucocyte counts may lead to misinterpreting gentamycin's effects as persistent infection.
- Clinical assessment must consider potential drug-induced changes in CSF parameters.
- This finding is crucial for accurate diagnosis and treatment adjustment in similar cases.