Abstract • This study analyzes the clinical and bacteriologic features of CSF infections that occurred in patients with neoplastic meningitis treated with thiotepa and methotrexate administered through a subcutaneous reservoir and ventricular catheter (SRVC). Thirty-one patients were treated, and CSF infections occurred in four (13%). Staphylococcus epidermidis was the infecting organism in each case and Pseudomonas maltophilia occurred with S epidermidis in one patient. Fever, headache, lethargy, and evidence of CSF extravasation around the SRVC were the common manifestations of infection. The CSF leukocytosis was the only laboratory abnormality noted. All infections were cured with the appropriate antibiotics and removal of the SRVC. Risk of CSF infection did not seem to be related to the use of high doses of dexamethasone, cranial radiation therapy, or the presence or absence of leukopenia. The SRVCs were replaced and treatment of neoplastic meningitis was resumed in three patients; infection did not recur. A CSF infection during management of neoplastic meningitis may be treated effectively and does not preclude adequate therapy of neoplastic meningitis. (Arch Intern Med 1982;142:583-586) References 1. Olson ME, Chernik NL, Posner JB: Infiltration of the leptomeninges by systemic cancer. Arch Neurol 1974;30:122-137.Crossref 2. Little JR, Dale AJD, Okazaki H: Meningeal carcinomatosis. Arch Neurol 1974;30:138-143.Crossref 3. Posner JB: Management of central nervous system metastases. Semin Oncol 1977;4:81-91. 4. Shapiro WR, Posner JB, Ushio Y, et al: Treatment of meningeal neoplasms. Cancer Treat Rep 1977;61:733-743. 5. Bleyer WA: Current status of intrathecal chemotherapy for human meningeal neoplasms. Natl Cancer Inst Monogr 1977;46:171-178. 6. Ratcheson RA, Ommaya AK: Experience with the subcutaneous cerebrospinal reservoir. N Engl J Med 1968;279:1025-1031.Crossref 7. Galkich JH, Guido LJ: Ommaya device in carcinomatous and leukemic meningitis. Surg Clin North Am 1974;54:915-922. 8. Shurtleff DB, Christie D, Foltz EL: Ventriculoauriculostomy-associated infection: A 12-year study. J Neurosurg 1971;35:686-694.Crossref 9. Schoenbaum SC, Gardner P, Shillito J: Infections of CSF shunts and epidemiology, clinical manifestations and therapy. J Infect Dis 1975; 131:543-552.Crossref 10. George R, Leibrock L, Epstein M: Long-term analysis of CSF shunt infections. J Neurosurg 1979;51:804-811.Crossref 11. McLaurin RL: Infected cerebrospinal fluid shunts. Surg Neurol 1973;1:191-195. 12. McLaurin RL: Treatment of infected ventricular shunts. Childs Brain 1975;1:306-310. 13. James HE, Walsh JW, Wilson HD, et al: Prospective randomized study of therapy in cerebrospinal fluid shunt infection. Neurosurg 1980; 7:459-463.Crossref 14. Venes JL: Control of shunt infection: Report of 150 consecutive cases. J Neurosurg 1976;45:311-314.Crossref 15. McCullough DC, Kane JG, Presper JH, et al: Antibiotic prophylaxis in ventricular shunt surgery: I. Reduction of operative infection rates with methicillin. Childs Brain 1980;7:182-189.
Archives of Internal Medicine – American Medical Association
Published: Mar 1, 1982