Limulus Endotoxin Assay and Meningitis

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To the editor: The article by Dr. Neu in the November issue (1) is a concise, well-organized review of the services available to the clinician from the microbiology laboratory. However, we are surprised that there is no mention of the limulus endotoxin assay as a rapid (60 minute), reliable method in the initial evaluation of meningitis. After Levin and Bang (2) observed that minute amounts of endotoxin created by gram-negative bacteria produced gelation of amoebocytes from Limulus polyphemus (horseshoe crab), multiple studies confirmed the usefulness of the limulus assay as an aid in the diagnosis of gram-negative meningitis (3–5). In

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