Acute versus subacute community-acquired meningitis

Abstract

Community-acquired meningitis can be classified into acute and subacute presentations by the duration of illness of ≤ or >5 days, respectively. There are currently no studies comparing the clinical features, management decisions, etiologies, and outcomes between acute and subacute presentations.It is a retrospective study of adults with community-acquired meningitis hospitalized in Houston, TX between January 2005 and January 2010. An adverse clinical outcome was defined as a Glasgow Outcome Scale score of ≤4.A total of 611 patients were identified, of which 458 (75%) were acute and 153 subacute (25%). The most common etiologies were unknown in 418 (68.4%), viral in 94 (15.4%), bacterial in 47 (7.7%), fungal in 42 patients (6.9%), and other noninfectious etiologies in 6 (1%). Patients with subacute meningitis were more likely to be immunosuppressed or have comorbidities, had fungal etiologies, and had higher rates of hypoglycorrachia and abnormal neurological findings (P <.05). Patients with an acute presentation were more likely to be treated empirically with intravenous antibiotics and had higher cerebrospinal fluid pleocytosis and serum white blood cell counts (P <.05). On logistic regression, age >65 years and abnormal neurological findings were predictive of an adverse clinical outcome in both acute and subacute meningitis, whereas fever was also a significant prognostic factor in acute meningitis. (P <.05).Acute and subacute meningitis differ in regards to clinical presentations, etiologies, laboratory findings, and management decisions, but did not differ in rates of adverse clinical outcomes. Future studies including thoroughly investigated patients with new diagnostic molecular methods may show different results and outcomes.

The diagnostic utility of the “Thwaites’ system” and “lancet consensus scoring system” in tuberculous vs. non-tuberculous subacute and chronic meningitis: multicenter analysis of 395 adult patients

“…Inclusion Criteria: a) adult patient (age > 14 years); b) symptoms of meningitis (fever, headache, stiff neck, altered mental status or focal neurological symptoms); c) duration of symptoms more than 5 days; d) CSF white cell count > 5 cells/mm 3 [ 1 ]. A total of 233 non TBM-patients were identified who presented to an emergency department (ED) between January 1, 2005 and January 1, 2015 at 9 Memorial Hermann hospitals and to Lyndon B Johnson Hospital in Houston, Texas.…”

“…Meningitis can be categorized as acute and subacute based on duration of symptoms [ 1 ]. Subacute meningitis (SAM) is commonly defined as inflammation evolving for greater than 5 days and less than 30 days and chronic meningitis (CM) as greater than 30 days without resolution of cerebrospinal fluid (CSF) abnormalities [ 1 ].…”

“…Meningitis can be categorized as acute and subacute based on duration of symptoms [ 1 ]. Subacute meningitis (SAM) is commonly defined as inflammation evolving for greater than 5 days and less than 30 days and chronic meningitis (CM) as greater than 30 days without resolution of cerebrospinal fluid (CSF) abnormalities [ 1 ]. The majority of adult patients with community-acquired meningitis (CAM) is admitted and receives empiric antimicrobial therapy pending the results of CSF cultures [ 2 ].…”

Tuberculous Meningitis: Pathogenesis, Immune Responses, Diagnostic Challenges, and the Potential of Biomarker-Based Approaches

“…Besides TBM, infectious meningitis is also commonly caused by viruses, bacteria, and fungi, which are often challenging to differentiate from meningitis caused by TB ( 8 ). In both children and adults, viral meningitis is more common, followed by bacterial and fungal meningitis ( 9 – 11 ). Streptococcus pneumoniae is the most common cause of bacterial meningitis worldwide in both adults and children, followed by Neisseria meningitidis ( 8 , 12 ).…”

Encefalitis autoinmune-encefalitis límbica. Caso clínico

“…Este escenario está relacionado con causas agudas metabólicas, tóxicas e infecciosas, siendo está última la más común, vinculada a déficit temporal o permanente según el agente etiológico. 2,3 La encefalitis autoinmune se presenta como un cuadro subagudo con fuerte asociación infecciosa en los casos pediátricos. Sin embargo, en los últimos 20 años la frecuencia de casos no infecciosos ha aumentado de manera significativa.…”