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Factitious meningitis: a recurring problem.

R L Penn1, R Normand, S A Klotz

  • 1Department of Medicine, Veterans Administration Medical Center, Shreveport, LA 71101-4295.

Infection Control and Hospital Epidemiology
|November 1, 1988
PubMed
Summary
This summary is machine-generated.

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Contaminated lumbar puncture trays led to false-positive gram-negative bacilli results in cerebrospinal fluid (CSF) smears, mimicking meningitis. This contamination issue was resolved by using separate sterile collection tubes for CSF specimens.

Area of Science:

  • Microbiology
  • Clinical Diagnostics
  • Infectious Diseases

Background:

  • Gram-negative meningitis is a rare but serious infection.
  • Clusters of positive cerebrospinal fluid (CSF) smears for gram-negative bacilli were observed.
  • No CSF cultures confirmed bacterial growth, suggesting an alternative explanation.

Purpose of the Study:

  • To investigate the cause of recurrent false-positive CSF smears for gram-negative bacilli.
  • To identify the source of contamination in diagnostic procedures.
  • To prevent future occurrences of factitious meningitis diagnoses.

Main Methods:

  • Analysis of cerebrospinal fluid (CSF) smears and cultures from patients.
  • Testing of commercial lumbar puncture and myelogram trays for microbial contamination.

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  • Retrospective review of laboratory records and patient charts.

    • Main Results:

    • Nonviable gram-negative bacilli were detected in commercial specimen tubes and manometers.
    • Contamination levels varied significantly between lots and types of medical devices.
    • Diagnosis of factitious meningitis was confirmed in all affected patients.
    • The issue ceased after implementing the use of separate sterile tubes for CSF collection.

    Conclusions:

    • Nonviable contaminants in commercial diagnostic products can cause false-positive CSF gram-stained smears.
    • Healthcare professionals and laboratories must be aware of potential contamination sources.
    • Implementing procedural changes, such as using sterile collection tubes, can effectively resolve contamination issues.