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Factitious Meningitis: A Recurring Problem

Published online by Cambridge University Press:  21 June 2016

Robert L. Penn ,
Richard Normand  and
Stephen A. Klotz
Robert L. Penn*
Affiliation:
Departments of Medicine and Nursing, Veterans Administration Medical Center, and Louisiana State University School of Medicine, Shreveport, Louisiana
Richard Normand
Affiliation:
Departments of Medicine and Nursing, Veterans Administration Medical Center, and Louisiana State University School of Medicine, Shreveport, Louisiana
Stephen A. Klotz
Affiliation:
Departments of Medicine and Nursing, Veterans Administration Medical Center, and Louisiana State University School of Medicine, Shreveport, Louisiana
*
(HHD), VA Medical Center, 510 E. Stoner Avenue, Shreveport, LA 71101-4295
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Abstract

Although gram-negative meningitis is rare in our hospital, between July, 1982 and July, 1983 clusters of cerebrospinal fluid (CSF) smears were reported positive for gram-negative bacilli. Fourteen specimens were obtained by diagnostic lumbar punctures, and one was obtained during a myelogram. No CSF cultures were positive, and a diagnosis of factitious meningitis was eventually established for each patient. Nonviable gram-negative bacilli were found in 6.7% of manometers, and 23.3% to 90% of the specimen tubes tested from the same lots of commercial lumbar puncture trays. It was estimated that there were between 44 and 333 organisms per specimen tube. Two lots of the commercial myelogram trays yielded nonviable gram-negative bacilli from 50% of the specimen tubes and 33.3% of the manometers tested. Retrospective review of laboratory records for 1982 and 1983 revealed 23 total CSF smears positive for gram-negative bacilli. No CSF grew gram-negative bacilli, and chart reviews confirmed a diagnosis of factitious meningitis in each case. In addition to the clusters of false-positive smears, this had occurred sporadically in both years. The problem did not recur after separate sterile tubes were provided for CSF collection. Physicians and laboratories should be aware that nonviable contaminants in commercial products may be a source of false-positive CSF gram-stained smears.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 9 , Issue 11 , November 1988 , pp. 501 - 503
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1988

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References

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