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Bacterial meningitis complicating the course of liver cirrhosis
Pasquale Pagliano1, Giovanni Boccia2, Francesco De Caro2
1Department of Infectious Diseases, AORN dei ColliD. Cotugno Hospital, Naples, Italy.
Abstract:
Meningitis is rarely reported in studies investigating bacterial infections in patients affected by liver cirrhosis. We investigated the findings of bacterial meningitis in patients affected by liver cirrhosis referred to our department in a 16-year period.
Materials:
Patients with cirrhosis and bacterial meningitis were enrolled. Cirrhosis was defined by liver histology or clinical, laboratory, and ultrasonographic and endoscopic findings. Bacterial meningitis was defined by cerebro-spinal fluid pleocytosis (>10/mcl) and characteristic clinical presentation. Fisher exact test and Wilcoxon rank-sum test were employed as appropriate for statistical analysis.
Results:
Forty-four patients with bacterial meningitis and cirrhosis were enrolled in the study. Sex ratio (male:female) was 1.4:1 and median (IQR) age was 64 (55-72) years. Cirrhosis was viral in 40 patients. At admission, median (IQR) MELD score was 12 (9-14), and median (IQR) Child-Pugh score was 8 (6-10). Other conditions associated with immunodepression were present in 22 (50%) cases. Streptococcus pneumoniae and Listeria monocytogenes were the agents more frequently identified. An extra-meningeal focus of infection was identified in 17 (39%) cases. Main symptoms at admission were fever, nuchal rigidity, and an obtunded or comatose status, and at least 2 of these were reported in 37 (84%) episodes. Cerebro-spinal fluid showed high cells, low CSF/serum glucose ratio, and elevated protein. Seventeen patients (39%) died and 8 (18%) reported sequelae. High MELD and Child-Pugh scores were related to the mortality risk (p < 0.001). The findings of blood and cerebro-spinal fluid analysis were not predictive of outcome.
Conclusions:
Bacterial meningitis should be considered in cirrhotics presenting with fever and altered conscience status. MELD and Child-Pugh scores predicted prognosis.
Insights
Bacterial meningitis is a rare but serious infection in liver cirrhosis patients. High MELD and Child-Pugh scores indicate a poor prognosis, emphasizing the need for prompt consideration of meningitis in these individuals.
Area of Science:
- Infectious Diseases
- Hepatology
- Neurology
Background:
- Bacterial meningitis is infrequently documented in patients with liver cirrhosis.
- This study investigates the clinical characteristics and outcomes of bacterial meningitis in cirrhotic patients.
Purpose of the Study:
- To analyze the findings of bacterial meningitis in patients with liver cirrhosis.
- To identify predictors of mortality and sequelae in this patient population.
Main Methods:
- Retrospective analysis of 44 patients with cirrhosis and bacterial meningitis over 16 years.
- Cirrhosis and meningitis were diagnosed based on established clinical and laboratory criteria.
- Statistical analysis included Fisher exact test and Wilcoxon rank-sum test.
Main Results:
- The majority of cirrhosis cases were viral (40 patients).
- Common pathogens included Streptococcus pneumoniae and Listeria monocytogenes.
- Fever, nuchal rigidity, and altered consciousness were key symptoms; 39% of patients died, and 18% had sequelae.
- High MELD and Child-Pugh scores were significantly associated with mortality (p < 0.001).
Conclusions:
- Bacterial meningitis should be suspected in cirrhotic patients presenting with fever and altered mental status.
- Liver cirrhosis severity scores (MELD and Child-Pugh) are valuable prognostic indicators.
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