Differences in the courses of meningococcal and pneumococcal cerebrospinal meningitis

Area of Science:

• Infectious Diseases
• Neurology
• Critical Care Medicine

Background:

• Bacterial meningitis, primarily caused by Neisseria meningitidis and Streptococcus pneumoniae, presents a significant public health challenge with high mortality and complication rates in adults.
• Effective management and prognosis prediction for adult bacterial meningitis require understanding pathogen-specific clinical presentations and outcomes.

Purpose of the Study:

• To compare the clinical characteristics, hospitalisation course, and outcomes of adult patients with bacterial cerebrospinal meningitis (CSM) caused by Neisseria meningitidis versus Streptococcus pneumoniae.
• To identify factors associated with prognosis in adult bacterial meningitis.

Main Methods:

• A retrospective study was conducted on 98 adult patients diagnosed with bacterial CSM between 1998 and 2018.
• Data collected included patient demographics, comorbidities, clinical presentation (e.g., haemorrhagic rashes), cerebrospinal fluid (CSF) analysis (cytosis), occurrence of intravascular coagulation syndrome, hospitalisation duration, and mortality rates.
• Patients were stratified based on the causative pathogen: Neisseria meningitidis (n=42) and Streptococcus pneumoniae (n=56).

Main Results:

• Neisseria meningitidis patients were younger, had fewer comorbidities, and presented more frequently with haemorrhagic rashes compared to Streptococcus pneumoniae patients.
• Meningococcal CSM was associated with lower CSF cytosis (< 1,000 cells/mL), higher incidence of intravascular coagulation syndrome, shorter hospitalisation times, and lower mortality rates.
• Advanced age and CSF cytosis < 1,000 cells/μl were indicators of an unfavorable prognosis, irrespective of the pathogen.

Conclusions:

• Neisseria meningitidis meningitis typically affects younger individuals without prior disease, characterized by rapid symptom onset, leading to earlier diagnosis and better outcomes than Streptococcus pneumoniae meningitis.
• Despite pathogen differences, critical prognostic indicators for adult bacterial meningitis include advanced age and low cerebrospinal fluid white blood cell count.