Factitious meningitis. Diagnostic error due to nonviable bacteria in commercial lumbar puncture trays
R. A. Weinstein, F. W. Bauer, R. D. Hoffman, P. G. Tyler, R. L. Anderson and W. E. Stamm
A cluster of five false-positive cerebrospinal fluid (CSF) Gram stains led
to an investigation of possible causes of specimen or smear contamination.
Specimen tubes supplied in commercial lumbar puncture trays from the lot
being used in the involved hospital were shown to contain nonviable
bacteria, When filled with a test solution and processed in a manner
similar to that used for processing CSF specimens, 10 of 12 tubes evaluated
yielded Gram stains containing either Gram-negative rods, diplococci, or
coccobacilli. Before this problem was recognized, the patient from whom the
first false-positive smear was obtained was treated for bacterial
meningitis. It is important to realize that microbial contamination of
commercial CSF specimen tubes can result in findings simulating those of
early bacterial meningitis.
