HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lukes, S. A. Articles by Armstrong, D. Search for Related Content PubMed PubMed Citation Articles by Lukes, S. A. Articles by Armstrong, D.

Bacterial infections of the CNS in neutropenic patients

From the Departments of Neurology (Drs. Lukes and Posner), Pathology (Neuropathology) (Dr. Nielsen), and Medicine (Infectious Disease) (Dr. Armstrong), Memorial Sloan-Kettering Cancer Center, Cornell University Medical College, New York, NY.

In neutropenic patients, fever and mental status changes are frequently the only overt clinical manifestations of bacterial infections of the CNS. Prominent headache and meningeal signs are exceptional. CNS infections may occur even in patients receiving large doses of broad-spectrum antibiotics. CSF culture and Gram's stain are required to establish or exclude the diagnosis and are often positive, even in patients receiving antibiotics for other indications. The CSF cell counts and chemistries are helpful if abnormal, but, when normal, provide no assurance that infection is not present, The CSF glucose can be lowered in the absence of pleocytosis, but a low CSF glucose is neither sensitive (27% in this series) nor specific. Lumbar puncture is hazardous in many neutropenic patients because of simultaneous thrombocytopenia; lumbar puncture should be performed by an experienced physician after platelet transfusions. The outcome of CNS infection depends on the underlying clinical disorder and on bone marrow recovery. The use of third-generation cephalosporins, new semisynthetic penicillins, and intrathecal administration of aminoglycosides may improve outcome.

Address correspondence and reprint requests to Dr. Posner, 1275 York Avenue, New York, NY 10021.

Accepted for publication June 27, 1983.

This article has been cited by other articles:

				J. E. Safdieh, P. A. Mead, K. A. Sepkowitz, T. E. Kiehn, and L. E. Abrey Bacterial and fungal meningitis in patients with cancer Neurology, March 18, 2008; 70(12): 943 - 947. [Abstract] [Full Text] [PDF]

				N. L. Antunes Topical Review: Acute Neurologic Complications in Children With Systemic Cancer J Child Neurol, November 1, 2000; 15(11): 705 - 716. [Abstract] [PDF]

				J D Pollard and G A R Young Neurology and the bone marrow J. Neurol. Neurosurg. Psychiatry, December 1, 1997; 63(6): 706 - 717. [Full Text] [PDF]