Printer Friendly

Filamentous Forms of Escherichia coli in Cerebrospinal Fluid.

A 39-year-old man presented with severe frontal headache and neck pain. There was no history of head trauma or loss of consciousness. Physical examination revealed left ankle clonus, positive Babinski sign on the left, and left lower extremity weakness. A computed tomographic scan showed diffuse subarachnoid hemorrhage. An angiogram showed the presence of a basilar artery aneurysm. Coiling of the aneurysm was successfully performed. However, a subsequent computed tomographic scan showed development of hydrocephalus, for which a ventriculoperitoneal shunt was placed. Three days after shunt placement, the patient became febrile (38.4 [degrees] C). Laboratory tests of cerebrospinal fluid revealed the following values: white blood cell count, 495 X [10.sup.6]/L; red blood cell count, 18 960 X [10.sup.6]/L; glucose, 1.61 mmol/L (29 mg/dL); and protein, 4.44 g/L. The cerebrospinal fluid differential count was neutrophils, 96%, and lymphocytes, 4%. Gram stain of a cytospin smear showed numerous, long, gram-negative filamentous organisms (see Figure). Cultures of cerebrospinal fluid revealed the organism to be Escherichia coli.


Filamentous forms are seen when gram-negative bacteria are exposed to low concentrations of [Beta]-lactam antibiotics.[1,2] At these concentrations, nuclear division takes place, but actual separation of bacterial cells is prevented due to inhibition of septation.[3] This patient was on oxacillin sodium therapy for a week before he became febrile. The patient was subsequently treated with a regimen that included ceftazidime sodium. He responded to this therapy and was discharged 1 month after admission.


[1.] Gardner AD. Morphological effects of penicillin on bacteria. Nature. 1940; 146:837-838.

[2.] Lorian V, Atkinson B. Abnormal forms of bacteria produced by antibiotics. Am J Clin Pathol. 1975;64:678-688.

[3.] Burdett ID, Murray RG. Septum formation in Escherichia coli: characterization of septal structure and the effects of antibiotics on cell division. J Bacteriol. 1974;119:303-324.

Accepted for publication January 11, 2001.

From the Department of Pathology, Northwestern University Medical School, Chicago, Ill. Dr Kini is now with the Department of Pathology, Loyola University Medical Center, Maywood, Ill.

Reprints not available from the author.
COPYRIGHT 2001 College of American Pathologists
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2001 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Author:Kini, Ameet R.; Peterson, LoAnn C.
Publication:Archives of Pathology & Laboratory Medicine
Date:Jun 1, 2001
Previous Article:A 43-Year-Old Man With Fatigue and Night Sweats.
Next Article:Adult Ectopic Thymus Adjacent to Thyroid and Parathyroid.

Related Articles
Berries battle bladder bugs.
Escherichia coli 0157.H7 outbreak linked to home-cooked hamburgers.
There was a recent outbreak of E. coli where I live. What happens to your body when you're affected?
Cinnamon is a Lethal Weapon Against E. coli Bacteria.
Centrum obtains United States patent.
Single multiplex polymerase chain reaction to detect diverse loci associated with diarrheagenic Escherichia coli. (Dispatches).
Enteroaggregative Escherichia coli serotype O126:H27, Israel.
Antimicrobial-resistant invasive Escherichia coli, Spain.
Hemolytic uremic syndrome risk and Escherichia coli O157:H7.
Spontaneous Escherichia coli meningitis with subdural empyema in an adult.

Terms of use | Copyright © 2018 Farlex, Inc. | Feedback | For webmasters