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[Purulent meningitis at the Marselisborg Hospital 1980-1990]
B Hansen1, F T Black, P L Andersen
1Medicinsk-epidemisk afdeling A., Marselisborg Hospital, Arhus.
Abstract:
From 1980-1990 245 immunocompetent patients were admitted to The Department of Infectious Diseases, Marselisborg Hospital with purulent meningitis or meningococcal septicaemia. The clinical diagnosis was established by clinical examination and by neutrophil pleocytosis. The aetiological diagnosis was established by demonstration of bacteria in the cerebrospinal fluid by microscopy or culture and by blood culture. Clinical signs of disseminated intravascular coagulation (DIC) or demonstration of meningococcal antibodies (MAT) in serum were considered diagnostic for meningococcal disease. The group comprised 120 males and 125 females aged 0-90 years. One hundred and eleven (45%) had meningococcal disease, 69 (28%) had pneumococcal meningitis, and 20 (8%) had H. influenzae-meningitis. Other aetiologies occurred in one to six cases. No aetiology could be established in 25 (10%) patients. Patients with meningococcal and pneumococcal disease were treated with monotherapy with high doses of penicillin, and H. influenzae-meningitis was treated with ampicillin. In patients with meningitis of unknown aetiology penicillin was used, except in children below the age of five where ampicillin was used. In patients with meningococcal disease the mortality was 5.4%, and 17% developed sequelae. In pneumococcal meningitis the corresponding figures were 13% and 17%, and in H. influenzae-meningitis 0% and 5% respectively. Among 20 patients with other aetiologies one patient (5%) died, and eight (40%) developed sequelae, whereas one patient (4%) died, and one (4%) developed sequelae in the group with meningitis of unknown aetiology. No ampicillin-resistant H. influenzae-strains were demonstrated. We suggest that monotherapy with betalactam-antibiotics is still a valuable treatment for meningitis in Denmark.
Insights
High-dose penicillin monotherapy remains effective for treating bacterial meningitis, including meningococcal and pneumococcal infections, with low mortality and sequelae rates in immunocompetent patients. Amplicillin is effective for Haemophilus influenzae meningitis.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Bacteriology
Context:
- Retrospective analysis of 245 immunocompetent patients admitted between 1980-1990 with purulent meningitis or meningococcal septicaemia.
- Diagnosis confirmed by clinical examination, neutrophil pleocytosis, and bacterial identification in cerebrospinal fluid or blood cultures.
- Meningococcal disease diagnosed by clinical signs of disseminated intravascular coagulation (DIC) or positive meningococcal antibody test (MAT).
Purpose:
- To evaluate the clinical outcomes and treatment efficacy of bacterial meningitis and meningococcal septicaemia in immunocompetent patients.
- To assess the mortality and sequelae rates associated with different causative agents and treatment regimens.
- To determine the continued value of betalactam antibiotic monotherapy for meningitis in Denmark.
Summary:
- Meningococcal disease (45%), pneumococcal meningitis (28%), and H. influenzae meningitis (8%) were the primary causes. Mortality rates were 5.4% for meningococcal, 13% for pneumococcal, and 0% for H. influenzae meningitis.
- Sequelae rates were 17% for meningococcal, 17% for pneumococcal, and 5% for H. influenzae meningitis.
- High-dose penicillin monotherapy was used for meningococcal and pneumococcal meningitis, while ampicillin was used for H. influenzae meningitis and in children under five with unknown aetiology. No ampicillin-resistant H. influenzae strains were found.
Impact:
- Betalactam antibiotic monotherapy demonstrates continued value in treating bacterial meningitis, offering favorable outcomes.
- The study provides evidence supporting current treatment guidelines for bacterial meningitis in immunocompetent populations.
- Findings contribute to understanding the epidemiology and treatment effectiveness of common meningitis causes.