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Streptomycin in Tuberculous Meningitis : A Report of its Use in a One-year-old Infant *

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STREPTOMYCIN IN TUBERCULOUS MENINGITIS: A REPORT OF ITS USE IN A ONE-YEAR-OLD INFANT* ROBERT E. COOKE, DONAL L. DUNPHY, AND FRANCIS G. BLAKE Tuberculous meningitis is universally considered to be a fatal disease. Examples of spontaneous recovery have been reported, but they are rare and complete laboratory confirmation in most of these is lacking. In January, 1944, Schatz, Bugie, and Waksman2 reported the isolation of streptomycin. In November, 1944, Schatz and Waks- mat3 demonstrated its marked bacteriostatic and bactericidal action against a human strain of Mycobacterium tuberculosis in vitro. In December, 1944, Feldman and Hinshaw' first showed the suppres- sive effect of streptomycin on "the pathogenic proclivities in guinea pigs of the human variety of Mycobacterium tuberculosis." The following case is cdescribed 'because ( 1 ) the use of strepto- mycin in the treatment of human tuberculous meningitis has not been reported, (2) streptomycin seemed to modify favorably the course of the disease, and (3) this is the first detailed report of the adminis- tration of streptomycin by the intrathecal route. Report of case History: M. M., an Irish-American girl, aged one year, was admitted to the New Haven Hospital on May 12, 1945, with convulsions. One and one-half hours before admission she had a generalized clonic convulsion with mild cyanosis. There were no previous signs or symptoms of illness. Examination: At the time of the baby's admission her temperature was 100.80 F. and respirations were 20. Her convulsions continued until sodium pentothal was administered intravenously. The only other abnormal physical signs were dullness and suppression of breath sounds over the left upper chest anteriorly and posteriorly. The total white blood cell count on admission was 20,500 with 60 per cent polymorphonuclear leukocytes and 40 per cent lymphocytes. Intra- cutaneous tests with old tuberculin (0.1 mg.) were markedly positive on two occasions. Lumbar puncture was performed on the sixth hospit

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