Vitamin C and SARS coronavirus.

1049 procedure, the patient developed fever (38°C), lethargy and neck stiffness. Analysis of ventricular CSF revealed 105 white cells/mm 3 (90% of the white cells were neutrophils), a glucose level of 23 mg/dL (glucose level in the blood: 106 mg/dL) and protein of 119 mg/dL. Microscopic examination of the Gram staining showed yeast and no other microorganisms. Cultures were positive for C. albicans in three separate samples. The blood culture was sterile. The patient had been treated with fluconazole 400 mg intravenously (iv) daily, oxacillin 12 g iv daily, rifampicin 600 mg iv daily, but meningitis persisted. Twenty days after the stroke, the patient was admitted to our Infectious Diseases unit. The external shunt was removed and replaced immediately , and therapy with AmBisome (3 mg/kg/day) and flucytosine (150 mg/kg/day) was started. In addition, on days 7–9 of the new treatment, intraventricular amphotericin B deoxycholate was injected into the shunt at a dose of 4 mg daily (the shunt was closed for 4 h). Despite this therapy, the patient had a torpid clinical course; his fluids and clinical condition improved but without complete resolution. CSF culture was positive until the 7th day of therapy and after this was negative. Following 23 days of this drug regimen, serial CSF and serum samples were taken to check amphotericin B levels. Some samples were also taken during intraventricular infusion. All samples were stored at –80°C until assay. After 30 days, the patient died as a result of a second haemorrhagic stroke. Amphotericin B concentrations in the patient's CSF and serum samples were analysed by HPLC, as described by Bekersky et al. 1 We performed standard curves for amphotericin B by regression analysis. The peak serum level of amphotericin B was 15.61 mg/L and the area under the concentration– time curve (AUC) was 115.5 mg·h/L. Amphotericin B concentrations in ventricular CSF were between 0.09 and 0.24 mg/L (AUC 3.7 mg·h/L). Concentrations of ventricular amphotericin B taken after intrathecal administration (range +7, +24 h after intra-shunt infusion) were between 100.5 and 1.75 mg/L. The concentration of amphotericin B in lumbar fluid was 0.59 mg/L (the fluid sample was obtained by single lumbar puncture, 48 h after intra-shunt infusion of amphotericin B and 22 h after AmBisome iv). One major concern, for therapy of fungal shunt infections, is CSF penetration of systemically administered amphotericin B. Currently, C. albicans is considered susceptible to amphotericin B at a …