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Clinical features, outcome, and meningococcal genotype in 258 adults with meningococcal meningitis: a prospective

Sebastiaan G B Heckenberg1, Jan de Gans, Matthijs C Brouwer

  • 1From Departments of Neurology (SGBH, JdG, MCB, DvdB) and Medical Microbiology (JRP, LS, AvdE), and Netherlands Reference Laboratory of Bacterial Meningitis (JRP, LS, AvdE), Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam; and Department of Neurology (MW), Kennemer Gasthuis, Haarlem, The Netherlands.

Medicine
|July 16, 2008
PubMed

Insights

Meningococcal meningitis, a severe infection caused by Neisseria meningitidis, often presents without the classic triad of symptoms. Delays in antibiotic treatment due to neuroimaging before lumbar puncture are common, impacting patient outcomes.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Epidemiology

Background:

  • Meningococcal meningitis caused by Neisseria meningitidis is a significant global health concern, particularly in young adults.
  • It is a leading cause of bacterial meningitis and septicemia worldwide.
  • Early diagnosis and treatment are crucial for improving patient outcomes.

Purpose of the Study:

  • To investigate the clinical presentation, diagnostic challenges, and outcomes of community-acquired bacterial meningitis in adults.
  • To identify factors associated with unfavorable outcomes in meningococcal meningitis.
  • To evaluate the impact of diagnostic procedures on treatment delays.

Main Methods:

  • A prospective observational cohort study of 258 adult patients with culture-confirmed bacterial meningitis in the Netherlands (October 1998-April 2002).
  • Clinical data, including neurological examinations and the Glasgow Outcome Scale, were collected.
  • Meningococcal isolates underwent serogrouping, multi-locus sequence typing, and susceptibility testing.

Main Results:

  • The classical triad of fever, neck stiffness, and altered mental status was present in only 27% of patients.
  • The addition of rash increased the diagnostic signs to at least two of four in 89% of cases.
  • Delay in antibiotic initiation was observed in 85% of patients who underwent computed tomography (CT) before lumbar puncture.
  • Overall unfavorable outcome was 12%, with a 7% mortality rate and 12% experiencing neurologic sequelae, including hearing loss.

Conclusions:

  • Meningococcal meningitis frequently presents with atypical symptoms, challenging early clinical diagnosis.
  • Pre-lumbar puncture neuroimaging significantly delays antibiotic administration, potentially worsening prognosis.
  • Infection with specific meningococcal strains (clonal complex 11) and sepsis are associated with poorer outcomes.

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