Related Experiment Video
Updated: Sep 4, 2025
Inducing Meningococcal Meningitis Serogroup C in Mice via Intracisternal Delivery
Published on: November 5, 2019
Characterization of Meningitis and Meningoencephalitis in the Israeli Defense Forces From 2004 to 2015: A
Shany Guly Gofrit1, Yoav Yechezkel Pikkel1,2, Hagai Levine3
1Medical Corps of the Israel Defense Forces, Haifa, Israel.
Background:
Meningitis and meningoencephalitis (MME) are potential medical emergencies. Mandatory reporting of all MME cases in the Israel Defense Force (IDF) allows accurate characterization of MME incidence and course. In the present study, we described the epidemiology of MME in soldiers.
Methods:
Medical charts of 860,000 combat and non-combat soldiers serving during the years 2004-2015, accounting for 2,256,060 patient years, were retrospectively evaluated. The diagnosis of MME was based on signs of meningeal irritation and a count of > 5 white blood cells (WBC) in the cerebrospinal fluid (CSF). Data on the diagnosis of bacterial or aseptic MME, significant sequelae, and associated mortality were collected.
Results:
Approximately 273 cases of MME were diagnosed. Overall, MME incidence was 12.1/100,000 patient-years. Bacterial and viral pathogens were identified in 31/273 (11.4%) and 52/273 (19%) cases, respectively. Combat soldiers had higher incidence of bacterial meningitis [14/40 (35%) vs. 31/212 (14.6%); p = 0.002] and meningoencephalitis [13/40 (32.5%) vs. 33/212 (15.6%); p = 0.023] compared to non-combat soldiers. Their clinical presentation was more severe, including confusion [10/40 (25%) vs. 22/212 (10.4%); p = 0.018], focal neurological deficits [12/40 (30%) vs. 11/212 (5.2%); p < 0.0001], and status epilepticus [3/40 (7.5%) vs. 0/212 (0.0%); p < 0.01]. Mortality among combat soldiers was higher [5/40 (15%) vs. 1/212 (0.5%); p < 0.001]. N. meningitidis was the most frequently isolated bacteria, despite universal preventative vaccination.
Conclusion:
The incidence of bacterial MME in the IDF is higher than in the civilian population. Combat soldiers present with higher incidence of meningoencephalitis and bacterial meningitis.
Insights
Meningitis and meningoencephalitis (MME) are serious infections. Combat soldiers in the Israel Defense Forces (IDF) experience higher rates of bacterial MME and more severe outcomes compared to non-combat soldiers.
Area of Science:
- Infectious Disease Epidemiology
- Military Medicine
- Neurology
Background:
- Meningitis and meningoencephalitis (MME) are critical medical conditions requiring prompt attention.
- Mandatory reporting in the Israel Defense Force (IDF) facilitates detailed MME epidemiology studies.
- This study aimed to characterize MME incidence and clinical course in soldiers.
Purpose of the Study:
- To describe the epidemiology of meningitis and meningoencephalitis (MME) in a large cohort of soldiers.
- To compare MME incidence, clinical presentation, and outcomes between combat and non-combat soldiers.
- To identify pathogens and risk factors associated with MME in military personnel.
Main Methods:
- Retrospective evaluation of medical charts for 860,000 soldiers (2004-2015).
- Diagnosis of MME based on meningeal irritation signs and cerebrospinal fluid (CSF) white blood cell (WBC) count.
- Data collection included MME type, sequelae, mortality, and pathogen identification.
Main Results:
- Overall MME incidence was 12.1 per 100,000 patient-years.
- Bacterial and viral pathogens identified in 11.4% and 19% of cases, respectively.
- Combat soldiers showed significantly higher incidence of bacterial meningitis and meningoencephalitis, more severe symptoms (confusion, neurological deficits, seizures), and increased mortality compared to non-combat soldiers.
Conclusions:
- Bacterial MME incidence in the IDF is higher than reported in the civilian population.
- Combat soldiers face a disproportionately higher burden of MME, particularly bacterial meningitis and meningoencephalitis.
- Neisseria meningitidis was the most common bacterial cause, despite vaccination efforts.
