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Ventricular Fluid and the Management of Coccidioidal Meningitis

ELLIOT GOLDSTEIN, M.D.; M. J. WINSHIP, M.D.; and DEMOSTHENES PAPPAGIANIS, M.D., Ph.D.
[+] Article and Author Information

Supported in part by grants APO 0628 and 01239, National Institutes for Environmental Health, and Training Grant 5 TO1 AI 00384, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.; and in part by contract DADA 17-69-C-9061, the Armed Forces Epidemiological Board (U.S. Army R and D), Commission on Acute Respiratory Diseases, Washington, D.C.

▸Requests for reprints should be addressed to Elliot Goldstein, M.D., Department of Internal Medicine, School of Medicine, University of California at Davis, Davis, Calif. 95616.


Davis and Sacramento, California


Ann Intern Med. 1972;77(2):243-246. doi:10.7326/0003-4819-77-2-243
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An Ommaya reservoir is often used to administer chemotherapy in the treatment of fungal meningitis. Since management of these chronic infections requires periodic analyses of cerebrospinal fluid, there is a tendency to obtain specimens from this site rather than from repeated lumbar taps. In three cases of meningitis due to Coccidioides immitis, one of which was complicated by a staphylococcal superinfection, analysis of ventricular fluid obtained from the reservoir was diagnostically misleading. This fluid usually showed protein concentrations of less than 30 mg/100 ml, glucose concentrations of more than 57 mg/100 ml, falsely low complement-fixing antibody titers, and small numbers of cells. Spinal fluid from the lumbar space showed the characteristic abnormalities associated with meningitis, in protein, glucose, and cellular constituents. This masking effect is caused by physiological differences between ventricular and lumbar fluid and can be great enough to limit the diagnostic value of ventricular fluid.

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