Eti ology and Epidemi ology of Bacterial Meningitis in Adults
Authors:
O. Džupová 1; S. Polívková 1; D. Smíšková 2; A. Gabrielová 3; J. Beneš 1
Authors‘ workplace:
FN Na Bulovce, Praha
Univerzita Karlova, 3. lékařská fakulta, II. infekční klinika, 2Univerzita Karlova, 2. lékařská fakulta, I. infekční klinika, 3Oddělení klinické mikrobiologie
1
Published in:
Cesk Slov Neurol N 2009; 72/105(4): 331-335
Category:
Original Paper
Overview
Objectives:
The aim of the presented part of study was to describe epidemi ological characteristics of adult bacteri al meningitis and detect the prognostic significance of selected pathogens for the risk of fatal o utcome and sequelae. Materi al and methods: Prospective observati onal longitudinal study of adult pati ents tre ated for bacteri al meningitis at a speci alized unit. Anamnestic, clinical and laboratory data, complicati ons and o utcomes were recorded. Eti ological agent was identifi ed in the cerebrospinal fluid and blo od by me ans of culture, polymerase chain re acti on and latexagglutinati on. Results: From 1997– 2006, 296 adult pati ents (128 women, 168 men) with acute bacteri al meningitis, age range 16– 85 ye ars and medi an age 51 ye ars, were hospitalized. The most frequent pathogens were Streptococcus pne umoni ae in 27.7% and Neisseri a meningitidis in 25.4% of pati ents. Listeri a monocytogenes was the pathogen in 7.1%, staphylococci in 6.1% and gramnegative rods in 5.4% of pati ents. Eti ology was not identifi ed in 24% of pati ents. Pne umococci and gramnegative rods carri ed the highest case fatality rati o. Fifty- nine pati ents di ed (20%) and 54 pati ents (18%) survived with permanent sequelae. Gramnegative rods proved to be a predictor of risk of de ath and meningococci were conversely predictor of low risk of de ath. Multivari ant analysis did not confirm any pathogen as predictive for risk of sequelae; meningococci and unidentifi ed eti ology were associ ated with less sequelae. Conclusi on: Bacteri al meningitis remains to carry significant morbidity and case fatality rati o. S. pne umoni ae and N. meningitidis were the most frequent pathogens in the current study altho ugh many other bacteri al speci es were identifi ed. It is advisable to incre ase the eti ology identificati on rate by me ans of rigoro us sending of cerebrospinal fluid and blo od for culture and enhanced availability of molecular di agnostic techniques for detecti on of all potenti al agents of meningitis.
Key words:
bacterial meningitis – etiological agent – fatal outcome – sequelae
Sources
1. van de Beek D, de Gans J, Tunkel AR, Wijdicks EF. Community- acquired bacteri al meningitis in adults. N Engl J Med 2006; 354(1): 44– 53.
2. Weisfelt M, van de Beek D, Spanjaard L, Reitsma JB, de Gans J. Community-acquired bacteri al meningitis in older pe ople. J Am Geri atr Soc 2006; 54(10): 1500– 1507.
3. Grimwo od K, Nolan TM, Bond L, Anderson VA, Catroppa C, Keir EH. Risk factors for adverse o utcome of bacteri al meningitis. J Paedi atr Child He alth 1996; 32(5): 457– 462.
4. Epidat, Národní referenční centrum pro analýzu epidemi ologických dat. Dostupné z URL: http:/ / www.szu.cz/ data/ infekce- v- cr.
5. Kriz P. Surveillance of invasive meningococcal dise ase in the Czech Republic. Euro Surveill 2004; 9(11): 37– 39.
6. Swartz MN. Bacteri al meningitis: a vi ew of the past 90 ye ars. N Engl J Med 2004; 351(18): 1826– 1828.
7. Durand ML, Calderwo od SB, Weber DJ, Miller SI, So uthwick FS, Caviness VS jr et al. Acute bacteri al meningitis in adults. A revi ew of 493 episodes. N Engl J Med 1993; 328(1): 21– 28.
8. Kastenba uer S, Pfister HW. Pne umococcal meningitis in adults. Spectrum of complicati ons and prognostic factors in a seri es of 87 cases. Brain 2003; 126(5): 1015– 1025.
9. Lu CH, Hu ang CR, Chang WN, Chang CJ, Cheng BC, Lee PY et al. Community- acquired bacteri al meningitis in adults: the epidemi ology, timing of appropri ate antimicrobi al therapy, and prognostic factors. Clin Ne urol Ne urosurg 2002; 104(4): 352– 358.
10. McMillan DA, Lin CY, Aronin SI, Qu agli arello VJ. Community- acquired bacteri al meningitis in adults: categorizati on of ca uses and timing of de ath. Clin Infect Dis 2001; 33(7): 969– 975.
11. Miner JR, Heegaard W, Mapes A, Biros M. Presentati on, time to antibi otics, and mortality of pati ents with bacteri al meningitis at an urban co unty medical center. J Emerg Med 2001; 21(4): 387– 392.
12. Pfister HW, Feiden W, Einhäupl KM. Spectrum of complicati ons during bacteri al meningitis in adults: results of a prospective clinical study. Arch Ne urol 1993; 50(6): 575– 581.
13. Sigurdardóttir B, Björnsson OM, Jónsdóttir KE, Erlendsdóttir H, Gudmundsson S. Acute bacteri al meningitis in adults. A 20- ye ar overvi ew. Arch Intern Med 1997; 157(4): 425– 430.
14. Tang LM, Chen ST, Hsu WC, Lyu RK. Acute bacteri al meningitis in adults: a hospital‑based epidemi ological study. QJM 1999; 92(12): 719– 725.
15. van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Verme ulen M. Clinical fe atures and prognostic factors in adults with bacteri al meningitis. N Engl J Med 2004; 351(18): 1849– 1859.
16. Weiss W, Figuero a W, Shapiro WH, Flippin HF. Prognostic factors in pne umococcal meningitis. Arch Intern Med 1967; 120(5): 517– 524.
17. Aronin SI, Peduzzi P, Qu agli arello VJ. Community- acquired bacteri al meningitis: risk stratificati on for adverse clinical o utcome and effect of antibi otic timing. Ann Intern Med 1998; 129(11): 862– 869.
18. Flores- Cordero JM, Amaya- Villar R, Rincón- Ferrari MD, Le al- Noval SR, Garnacho- Montero J, Llanos- Rodríguez AC et al. Acute community- acquired bacteri al meningitis in adults admitted to the intensive care unit: clinical manifestati ons, management and prognostic factors. Intensive Care Med 2003; 29(11): 1967– 1973.
19. Hussein AS, Shafran SD. Acute bacteri al meningitis in adults. A 12 ye ar revi ew. Medicine (Baltimore) 2000; 79(6): 360– 368.
20. Meyer CN, Samuelsson IS, Galle M, Bangsborg JM. Adult bacteri al meningitis: aeti ology, penicillin susceptibility, risk factors, prognostic factors and guidelines for empirical antibi otic tre atment. Clin Microbi ol Infect 2004; 10(8): 709– 717.
21. Motlová J, Beneš Č, Křížová P. Invazivní pneumokokové onemocnění v České republice v letech 2000–2006. Epidemiol Mikrobiol Imunol 2008; 57(1): 14–21.
22. Vít M, Olejník R, Dlhý J, Karpíšková R, Částková J, Príkazský V et al. Předběžná zpráva o výskytu listeriózy v České republice v roce 2006. Zprávy CEM 2007; 16(1): 26–27.
Labels
Paediatric neurology Neurosurgery NeurologyArticle was published in
Czech and Slovak Neurology and Neurosurgery
2009 Issue 4
Most read in this issue
- Tumo urs of the Third Cerebral Ventricle
- Acquired Neuromyotonia with Minor Central Symptoms and Antibodies against Voltage- Gated Potassium Channels – a Case Report
- Botulinum Toxin in Spasticity Management
- Paroxysmal Kinesigenic Dyskinesi a – a Case Report of a Yo ung Woman with Alternating Hemidystoni a