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September 1980

Meningitis and Second Lumbar Puncture

Author Affiliations

Washington University Division of Hematology/Oncology Box 8125-660 South Euclid St Louis, MO 63110
Malankara Mission Hospital India

Arch Neurol. 1980;37(9):603. doi:10.1001/archneur.1980.00500580099027

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To the Editor.—  In response to Dr Magnussen's letter (Archives 37:398-399, 1980), we have the following comments.1. Considerations of space and brevity prevented us from providing detailed serial data on each patient. However, it is clearly stated under the "Materials and Methods" section that "in all patients whose condition did not show obvious improvement... antibiotic therapy was withheld on the basis of a shift to mononuclear predominance."2. The (admittedly poor) phrase "in up to 100% of patients" meant that although 100% of the cases in our study showed the shift, previous retrospective studies had occasional cases where the polymorphonuclear leukocytes persisted.3. The repeated spinal tap is performed because the patient's condition is not improving and there is significant doubt regarding the diagnosis. In the occasional patient in whom the spinal fluid still shows a polymorphonuclear predominance, we would consider it risky to continue to withhold antibiotic therapy. The

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