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Acute bacterial meningitis in adults: analysis of 218 episodes
1Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey.
Abstract:
A retrospective study was conducted to examine the laboratory, clinical features and outcome of 206 adult acute bacterial meningitis patients (218 episodes) during the years 1985-1996. Pneumonia (8.7 per cent), head trauma (7.8 per cent) and chronic otitis media (6.0 per cent) were identified as the main predisposing factors for acute bacterial meningitis. Aetiology was described only in 61 episodes (28.0 per cent). Streptococcus pneumonia was the most commonly identified pathogen overall, causing 33 of the 218 episodes (15.2 per cent). Antibiotic treatment before admission was given to 48.4 per cent of patients. On admission, the following symptoms of meningitis were predominant: 83 per cent had neck stiffness, 81 per cent had a headache and 73 per cent had fever. Case fatality rate was 27.1 per cent (59 patients). The important factors in mortality were as follows: old age, a long duration of symptoms before admission, a lack of neck stiffness, obtunded mental state on admission, low glucose levels in first CSF, low CSF/blood glucose ratio, and abnormality in computerised tomography scanning.
Insights
This study on adult acute bacterial meningitis found pneumonia, head trauma, and otitis media as common predisposing factors. Streptococcus pneumoniae was the leading cause, with a significant case fatality rate influenced by age and clinical presentation.
Area of Science:
- Infectious Diseases
- Neurology
- Clinical Medicine
Background:
- Acute bacterial meningitis remains a significant cause of morbidity and mortality in adults.
- Identifying predisposing factors and common pathogens is crucial for effective management.
Purpose of the Study:
- To investigate the laboratory and clinical features, predisposing factors, and outcomes of adult acute bacterial meningitis.
- To determine the most common etiological agents and factors associated with mortality.
Main Methods:
- Retrospective analysis of 206 adult patients (218 episodes) diagnosed with acute bacterial meningitis between 1985 and 1996.
- Examination of predisposing factors, causative pathogens, clinical symptoms, laboratory findings (including CSF glucose and CSF/blood glucose ratio), and CT scan results.
- Assessment of case fatality rate and identification of mortality-associated factors.
Main Results:
- Pneumonia, head trauma, and chronic otitis media were the primary predisposing factors.
- Streptococcus pneumoniae was the most frequent pathogen (15.2%).
- Key symptoms included neck stiffness (83%), headache (81%), and fever (73%). The case fatality rate was 27.1%.
Conclusions:
- Factors such as advanced age, delayed admission, absence of neck stiffness, altered mental status, low CSF glucose, low CSF/blood glucose ratio, and abnormal CT scans were linked to increased mortality.
- Early recognition and management strategies targeting these factors are essential for improving outcomes in acute bacterial meningitis.