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Bacterial Meningitis

Journal, Blood - 8/30/2009

Yup. If it isn't one thing it's the other.

After surgery yesterday to remove the ommaya reservoir they determined the original "leak" was from inside near the spine where the catheter entered the lumbar (lower mid back). Since that never healed tight, the CSF fluid was tunneling along the catheter and pooling around the reservoir under his skin by the right side (ribcage). That would explain why the reservoir incision didn't heal completly and finally sprung a leak two days ago (an entire month after the operation). It would also explain why there was CSF fluid bubbling out of the needle punctures after several of the ommaya taps this past month.

After the operation yesterday to remove it, Jaymun perked up for a few hours, but then spiked a fever and started vomiting. They found bacteria in the CSF fluid from the reservoir ...Streptococcus Viridans. Since this is NOT a skin bacteria, the infectious disease doctor reasoned that Jaymun was infected prior to the visible leak on his side. Combined with the clinical symptoms, he thinks that because there was enough bacteria to show up on a Gram Stain - it was more than just bacteria in the device itself or contamination from the removal operation.

Apparently every time we brush our teeth or move our bowels, we create an opportunity for these little bugs to temporarily enter our bloodstream. Bacteremia (living bugs in our blood) is not normal, but by brushing our teeth, or even merely clenching our jaws for a few seconds, we send a burst of the little critters into our bloodstream (temporary bacteremia). Even if they are relatively benign or even helpful other places (see my post last August), they shouldn't be in our blood, so our immune system normally clamps down on them within seconds or minutes. However, I just described a breakdown in his blood-brain-barrier that caused CSF fluid to pool around an area that was being punctured several times per week. It seems that slight elevation in risk was enough for Strep Viridans to take hold in his CSF.
Hence Bacterial Meningitis.
       The oral cavity as a reservoir of bacterial pathogens for focal infections.
       The normal colonic bacterial flora.
       Meningitis due to streptococcus viridans]
The ID doc confirmed that this kind of low-grade bacterial meningitis can hang around for a while. So if it has been here for a week or two, that could also account for some of the neurological symptoms I've been worrying about lately. At least a week ago I was noticing guarding, along with the unsteadyness that could also be blamed on the high Phenytoin levels (or tumor growth).

In any event, we're here for at least another day, and having a Picc line (semi-permanent IV) installed into his arm tomorrow to enable a week of IV antibiotics.