Outcomes of acute meningitis according to immunosuppression status: 15-year retrospective cohort

Area of Science:

• Neurology
• Infectious Diseases
• Immunology

Background:

• Acute meningitis is a significant global health issue.
• Immunosuppressed individuals face unique challenges with meningitis, including varied presentations and diverse pathogens.
• Understanding outcomes in this population is crucial for clinical management.

Purpose of the Study:

• To compare clinical features and outcomes of acute meningitis between immunosuppressed and immunocompetent adult patients.
• To identify factors influencing mortality in acute meningitis, considering immune status.

Main Methods:

• Retrospective cohort study of 189 adult patients with acute meningitis (January 2009 - December 2023).
• Exclusion of patients with postsurgical meningitis.
• Comparison of demographic, clinical, and laboratory data; mortality analyzed using multivariate logistic regression.

Main Results:

• 51% of patients were immunosuppressed, with a younger median age compared to immunocompetent patients.
• No significant differences in meningitis symptoms; the classical triad was uncommon in both groups.
• Immunosuppressed patients exhibited lower cerebrospinal fluid (CSF) glucose levels.
• Overall mortality was 20%, with no significant difference based on immune status.
• Independent predictors of death included age >50, altered mental status, and bacterial meningitis.

Conclusions:

• Acute meningitis in immunosuppressed hosts can present with attenuated inflammatory CSF profiles and a wider range of causes.
• Immunosuppression itself was not an independent predictor of in-hospital mortality.
• Age, altered mental status, and bacterial etiology are key determinants of mortality in acute meningitis.