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>While we are trashing common misperceptions about LPs...
>1. Where is there any evidence of a causal link between performing an
>LP and developing meningitis? Can we please eliminate the discussion of
>infection as a "risk" of doing an LP?
 
 
Although inconclusive, there is indeed evidence to suggest this.  Almost 40
years ago Petersdorf (1) was able to readily induce meningitis in animals
with pneumococcal bacteremia with a single LP, and "control" bacteremia
animals without LPs did not get meningitis.  Teele (2) reports cases of
bacteremic children who initially had clear LPs and were sent home; a day
or two later they returned with meningitis.
 
You can clean the skin before you perform LP, but you can't avoid sticking
your needle through bacteremic blood into the CSF.  Many physicians I know
routinely administer ceftriaxone before or during LP in any febrile child
in hopes of lowering this possible risk of CSF seeding.
 
Steve Green, MD
Professor of Emergency Medicine & Pediatrics
Loma Linda University Medical Center & Children's Hospital
 
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1.  Petersdorf PG, et al: Studies of the pathogenesis of meningitis: II.
Development of meningitis during pneumococcal bacteremia. J Clin Invest.
1962; 41: 320-327.
2.  Teele DW, et al:  Meningitis after LP in children with bacteremia.
NEJM 1981; 305:1079-1081.
 
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