Author:
Lien Chia-Yi,Chien Chun-Chih,Lu Cheng-Hsien,Chang Wen-Neng
Abstract
Abstract
Purpose
To examine the clinical characteristics of adult patients with community-acquired spontaneous bacterial meningitis (CASBM) with a fulminant clinical course.
Materials and methods
The clinical features and therapeutic outcomes of 127 adult CASBM patients were analyzed. The patients were divided into two groups as those with and without a fulminant clinical course. Fulminant clinical course was defined as meningitis presenting initially with marked consciousness disturbance (Glasgow Coma Scale score < 8) or a rapid deterioration in consciousness level within 48 h of hospitalization.
Results
Among the 127 enrolled patients, 69 had a fulminant clinical course (47 men and 22 women) and 58 did not. The patients with a fulminant clinical course had a significantly higher incidence of end-stage renal disease (ESRD), severe clinical manifestations and higher mortality rate, and the survivors had significantly worse therapeutic outcomes. Klebsiella (K.) pneumoniae (50 strains) was the most important pathogen for the development of a fulminant clinical course, and all strains were susceptible to ceftriaxone and ceftazidime. With treatment, 50.7% (35/69) of the patients with a fulminant clinical course died, and the presence of K. pneumoniae infection was significant prognostic factor.
Conclusions
The presence of ESRD, initial presentation of altered consciousness, septic shock, seizures and CSF total protein level and K. pneumoniae infection were significantly associated with a fulminant clinical course of adult CASBM, and patients with this specific infectious syndrome had high mortality and morbidity rates. The presence of K. pneumoniae infection is a significant prognostic factor.
Publisher
Springer Science and Business Media LLC
Reference45 articles.
1. Lien CY, Huang CR, Tsai WC, Hsu CW, Tsai NW, Chang CC, et al. Epidemiologic trend of adult bacterial meningitis in southern Taiwan (2006–2015). J Clin Neurosci. 2017;42:59–65.
2. Thakur KT, Wilson MR. Chronic meningitis. Continuum. 2018;24:1298–326.
3. Davis LE. Subacute and chronic meningitis. Continuum. 2006;12:27–57.
4. Muralidharan R, Mateen FJ, Rabinstein AA. Outcome of fulminant bacterial meningitis in adult patients. Euro J Neurol. 2014;21:447–53.
5. Lu CH, Chang WN, Chang HW. Adult bacterial meningitis in southern Taiwan: epidemiologic trend and prognostic factors. J Neurol Sci. 2000;182:36–44.