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Clinical features, complications, and outcome in adults with pneumococcal meningitis: a prospective case series
Martijn Weisfelt1, Diederik van de Beek, Lodewijk Spanjaard
1Department of Neurology, Centre of Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, 1100 DD Amsterdam, Netherlands.
Background:
Bacterial meningitis is a grave disease of high incidence, especially in less developed countries. Here, we describe its clinical presentation, spectrum of complications, prognostic factors, and outcome in adults with pneumococcal meningitis.
Methods:
From October, 1998, to April, 2002, we assessed 352 episodes of community-acquired pneumococcal meningitis, confirmed by culture of cerebrospinal fluid (CSF), which occurred in patients older than 16 years. Predictors for an unfavourable outcome (Glasgow outcome scale score 1-4) were identified by logistic regression with multiple imputation techniques.
Findings:
245 (70%) episodes of pneumococcal meningitis were associated with an underlying disorder. Cranial CT was done for 85% of episodes and revealed underlying disorders in 17% (50/299) and meningitis-associated intracranial complications in 39% (117/299). Independent predictors for an unfavourable outcome were a low score on the Glasgow coma scale, cranial nerve palsies, a raised erythrocyte sedimentation rate, a CSF leucocyte count less than 1000 cells per mm(3), and a high CSF protein concentration on admission. Overall in-hospital mortality was 30%. Prevalence of neurological and systemic complications did not differ between patients aged younger than 60 years and those aged 60 years and older; however, systemic complications were the cause of death in 59% (32/54) of fatal episodes in patients aged 60 years and older, whereas neurological complications were the cause of death in 65% (20/31) of fatal episodes in younger patients.
Interpretation:
Pneumococcal meningitis is associated with high mortality and morbidity rates in adults. Whereas neurological complications are the leading cause of death in younger patients, elderly patients die predominantly from systemic complications.
Insights
Pneumococcal meningitis in adults has high mortality and morbidity. Neurological complications cause death in younger patients, while systemic issues are the main cause of death in older adults.
Area of Science:
- Infectious Diseases
- Neurology
- Critical Care Medicine
Background:
- Bacterial meningitis, particularly pneumococcal meningitis, presents a significant global health challenge with high incidence rates, especially in developing nations.
- This study focuses on the clinical presentation, complications, prognostic factors, and outcomes of pneumococcal meningitis in adult patients.
Purpose of the Study:
- To elucidate the clinical characteristics, spectrum of complications, and prognostic indicators associated with pneumococcal meningitis in adults.
- To identify predictors of unfavorable outcomes and analyze mortality patterns in different age groups.
Main Methods:
- A cohort of 352 adult patients (older than 16 years) with culture-confirmed community-acquired pneumococcal meningitis was assessed between October 1998 and April 2002.
- Logistic regression with multiple imputation techniques was employed to identify predictors of unfavorable outcomes (Glasgow Outcome Scale score 1-4).
- Cranial computed tomography (CT) scans were utilized to identify underlying disorders and intracranial complications.
Main Results:
- Seventy percent of pneumococcal meningitis episodes were linked to an underlying disorder. Cranial CT revealed complications in 39% of cases.
- Independent predictors for poor outcomes included low Glasgow Coma Scale score, cranial nerve palsies, elevated erythrocyte sedimentation rate, low cerebrospinal fluid (CSF) leukocyte count (<1000 cells/mm³), and high CSF protein concentration.
- Overall in-hospital mortality was 30%. Neurological complications predominated as the cause of death in younger patients, whereas systemic complications were more frequent in older patients (≥60 years).
Conclusions:
- Pneumococcal meningitis in adults is associated with substantial mortality and morbidity.
- The leading causes of death differ significantly between younger and elderly patients, with neurological complications in the young and systemic complications in the elderly.
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