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Epidemiology and diagnosis of meningitis: results of a five-year prospective, population-based study
1Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham, B15 2TT. C.B.Jolly@bham.ac.uk
Abstract:
Implementation of the advice to give penicillin prior to admission, a fall in the lumbar puncture rate and the introduction into routine use of the meningococcal polymerase chain reaction (PCR) test are factors that have led us to reassess the way meningitis is diagnosed. We examined data for the period 1994-98 from a health district of 800,000 population. Of the 355 cases of meningitis reported, 258 (73%) had either confirmed, probable or possible meningococcal disease. Only 28% of meningococcal cases had received pre-admission benzylpenicillin. The proportion of suspected meningitis cases undergoing lumbar puncture fell over the period. It was 79% in 1994 and 61% in 1998 (p < 0.001). After meningococcal PCR was introduced in 1996, 73 (68%) meningococcal cases were microbiologically confirmed, compared to 72 (48%) before 1996 (p = 0.001). In all cases, age was an independent predictor of meningitis mortality, and for meningococcal cases, age and serogroup were independent predictors. Advice to general practitioners (GPs) to give preadmission benzylpenicillin to any suspected case of meningitis or meningococcal septicaemia should be reinforced regardless of age or whether a rash is present.
Insights
Reinforce advice for general practitioners to administer pre-admission benzylpenicillin for suspected meningitis or meningococcal septicaemia. Early penicillin use is crucial for better outcomes in bacterial meningitis cases.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Epidemiology
Background:
- Meningitis diagnosis has evolved with new guidelines and diagnostic tools.
- Changes include pre-admission penicillin advice, reduced lumbar puncture rates, and routine use of meningococcal polymerase chain reaction (PCR) testing.
- These shifts necessitate a re-evaluation of diagnostic practices for meningitis.
Purpose of the Study:
- To reassess meningitis diagnostic strategies in light of recent clinical and laboratory advancements.
- To evaluate the impact of pre-admission benzylpenicillin and meningococcal PCR on diagnosis and outcomes.
- To identify key predictors of meningitis mortality.
Main Methods:
- Retrospective analysis of meningitis cases (1994-1998) in a health district.
- Data collection on pre-admission benzylpenicillin use, lumbar puncture rates, and microbiological confirmation.
- Statistical analysis to determine the impact of interventions and identify mortality predictors.
Main Results:
- Of 355 meningitis cases, 258 (73%) involved meningococcal disease.
- Only 28% of meningococcal cases received pre-admission benzylpenicillin.
- Lumbar puncture rates decreased from 79% (1994) to 61% (1998).
- Meningococcal PCR introduction in 1996 increased confirmation rates from 48% to 68%.
- Age was an independent predictor of meningitis mortality.
Conclusions:
- Pre-admission benzylpenicillin advice for suspected meningitis/septicaemia should be reinforced for all patients.
- Meningococcal PCR significantly improves microbiological confirmation rates.
- Age and serogroup are critical factors in meningococcal meningitis mortality.