Characterization of Meningitis and Meningoencephalitis in the Israeli Defense Forces From 2004 to 2015: A Population-Based Study

Abstract

BackgroundMeningitis and meningoencephalitis (MME) are potential medical emergencies. Mandatory reporting of all MME cases in the Israel Defense Force (IDF) allows accurate characterization of MME incidence and course. In the present study, we described the epidemiology of MME in soldiers.MethodsMedical charts of 860,000 combat and non-combat soldiers serving during the years 2004–2015, accounting for 2,256,060 patient years, were retrospectively evaluated. The diagnosis of MME was based on signs of meningeal irritation and a count of > 5 white blood cells (WBC) in the cerebrospinal fluid (CSF). Data on the diagnosis of bacterial or aseptic MME, significant sequelae, and associated mortality were collected.ResultsApproximately 273 cases of MME were diagnosed. Overall, MME incidence was 12.1/100,000 patient-years. Bacterial and viral pathogens were identified in 31/273 (11.4%) and 52/273 (19%) cases, respectively. Combat soldiers had higher incidence of bacterial meningitis [14/40 (35%) vs. 31/212 (14.6%); p = 0.002] and meningoencephalitis [13/40 (32.5%) vs. 33/212 (15.6%); p = 0.023] compared to non-combat soldiers. Their clinical presentation was more severe, including confusion [10/40 (25%) vs. 22/212 (10.4%); p = 0.018], focal neurological deficits [12/40 (30%) vs. 11/212 (5.2%); p < 0.0001], and status epilepticus [3/40 (7.5%) vs. 0/212 (0.0%); p < 0.01]. Mortality among combat soldiers was higher [5/40 (15%) vs. 1/212 (0.5%); p < 0.001]. N. meningitidis was the most frequently isolated bacteria, despite universal preventative vaccination.ConclusionThe incidence of bacterial MME in the IDF is higher than in the civilian population. Combat soldiers present with higher incidence of meningoencephalitis and bacterial meningitis.

Atypical Presentation Resembling Acute Leukoencephalopathy With Restricted Diffusion in Staphylococcus aureus Meningoencephalitis

“…About 1.2 million people are annually affected with bacterial meningitis [ 7 ]. The incidence of meningitis and meningoencephalitis was 12.1/100,000 patient-years in a study by Gofrit et al [ 8 ]. The incidence of bacterial meningitis in Northern India ranged from 3% to 21.8% [ 7 ].…”

Invasive Disease Due to Neisseria meningitidis: Surveillance and Trends in Israel Prior to and during the COVID-19 Pandemic

“…Israel’s recommendations include MenACWY conjugate vaccines (risk groups and travelers) and protein-based MenB vaccines (risk groups mostly immune-compromised and children). The Israel Defense Forces (IDF) had adopted, some two decades ago, a MenACWY vaccination program aimed at army recruits and showing a decline in incidence in the IDF [ 37 , 38 ]. However, in Israel, most IMD cases occur in young children (in the current study, the IMD cases’ median age was three years), and most cases are attributed to serogroup B. Israel’s National Immunization Technical Advisory Group (NITAG) has recommended the use of the MenB vaccine in infants and toddlers in 2019 [ 39 ].…”

Clinical Features of BoDV-1 Encephalitis: A Systematic Review

“…Acute viral encephalitis is far from being a rare occurrence. According to the Centers for Disease Control and Prevention (CDC), approximately 20,000 cases of acute viral encephalitis are reported annually in the United States alone, with a case fatality ratio (CFR) ranging between 5 and 20% [63], 7.3 encephalitis hospitalizations per 100,000 people from 2000 to 2010 [63,64], and with around half of incident cases that do not reach a definitive diagnosis [64][65][66][67]. Although rare, BoDV-1 encephalitis was characterized as a very severe condition.…”

“…Despite the overall features of human BoDV-1 encephalitis, we were able to describe a severe clinical condition, with progressive loss of consciousness and coma, with the eventual death of affected patients within 4 to 10 weeks since the onset of clinical symptoms, and no specific features could be reconciled with BoDV-1 infection. In most reported cases, the onset of BoDV-1 (meningo)encephalitis was associated with very common, unspecific features, such as an influenza-like illness, fever > 38 • , and headache, a typical presentation for viral (meningo)encephalitis [63][64][65][66][67]. Cases of BoDV-1 encephalitis were then associated with a quite heterogeneous combination of signs and symptoms, including (but not limited to) convulsions, delirium, confusion, stupor or coma, aphasia or mutism, hemiparesis with asymmetry of tendon reflexes and Babinski sign, involuntary movements, ataxia and myoclonic jerks, nystagmus, ocular palsies, and facial weakness.…”