Community acquired meningitis/meningoencephalitis: Retrospective evaluation of five years

Abstract

Objective: This study was conducted in order to determine the etiological factors, morbidity, case fatality rate and cost of meningitis/meningoencephalitis cases followed in our clinic and to compare our data with national and international ones. Material and Methods: Fifty-one meningitis/meningoencephalitis cases followed in our clinic between April 2003 and May 2008 were evaluated retrospectively. Demographic characteristics and clinical data of the patients were obtained from the records. Diagnosis of meningitis/meningoencephalitis depended on cerebro spinal fluid (CSF) and radiological findings in the presence of clinical findings. Results: Among 51 patients, 29 (56.9%) were diagnosed as acute bacterial meningitis, 12 (23.5%) as viral meningoencephalitis and 10 (19.6%) as tuberculosis meningitis. Classical findings of meningitis such as fever, neck stiffness and change in conciuosness were present in 69% of the cases with acute bacterial meningitis, in 50% of the ones with viral meningitis, and in 40% of the ones with tuberculosis meningitis. Blood white blood cell count was 19.308/mm3 in acute bacterial meningitis, 10.389/mm3 in viral meningitis, and 9980/mm3 in tuberculosis meningitis. Increased blood white blood cell count was statistically significant in acute bacterial meningitis (p< 0.05). CSF white blood cell count was 4254.0/mm3 in acute bacterial meningitis, 282.5/mm3 in viral meningitis, and 365/ mm3 in tuberculosis meningitis. Causative pathogen was isolated in 15 (51.7%) of the 29 cases with acute bacterial meningitis; it was Streptococcus pneumoniae in 10 (34.4%), Listeria monocytogenes in 3 (10.34%), Staphylococcus aureus in 1 (3.4%), and Streptococcus pyogenes in one (3.4%) patient. Mycobacterium tuberculosis was isolated in CSF culture in 2 (20%) of the 10 patients with tuberculosis meningitis. CSF was positive for HSV-DNA with PCR in two of 12 patients with viral meningoencephalitis. Mean period of hospitalization was 17.76 days in patients with community acquired meningitis/meningoencephalitis; this period was significantly longer in the tuberculosis meningitis cases (p< 0.05). Mean cost of hospitalization and medication was 4860.95 USD for the cases with community acquired meningitis/meningoencephalitis. No mortality was seen in the cases with viral meningoencephalitis, whereas case fatality rate was 37.9% (11/29) in acute bacterial meningitis and 10% (1/10) in tuberculosis meningitis. Three cases with viral meningoencephalitis, two cases with acute bacterial meningitis and two cases with tuberculosis meningitis healed with sequelae. Conclusion: Despite developments in medicine, cases with meningitis/meningoencephalitis require prolonged hospitalization, have high fatality rate and cost, and the disease leads to serious sequelae. © 2010 by Türkiye Klinikleri.