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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.

[ILLUSTRATION OMITTED]

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.

References

[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.

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Author:Kini, Ameet R.; Peterson, LoAnn C.
Publication:Archives of Pathology & Laboratory Medicine
Date:Jun 1, 2001
Words:351
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