Recurrent Community-Acquired Bacterial Meningitis in Adults

Abstract

Background Recurrent bacterial meningitis has been found to occur in about 5% of meningitis cases. Methods We analyzed adults with recurrent episodes in a prospective nationwide cohort study of community-acquired bacterial meningitis. Results Of 2264 episodes of community-acquired bacterial meningitis between 2006 and 2018, 143 (6%) were identified as recurrent episodes in 123 patients. The median age was 57 years (interquartile range [IQR], 43–66), and 57 episodes (46%) occurred in men. The median duration between the first and the current episode was 5 years (IQR, 1–15). For 82 of 123 patients (67%), it was the first recurrent episode, 31 patients had 2–5 previous episodes (25%), 2 had 6–10 episodes (2%), and 2 had >10 episodes (2%). Predisposing factors were identified in 87 of 118 patients (74%) and most commonly consisted of ear or sinus infections (43 of 120, 36%) and cerebrospinal fluid leakage (37 of 116, 32%). The most common pathogens were Streptococcus pneumoniae (93 of 143, 65%) and Haemophilus influenzae (19 of 143, 13%). The outcome was unfavorable (Glasgow outcome scale score, <5) in 24 episodes with recurrent meningitis (17%) vs 810 for nonrecurrent meningitis patients (39%, P < .001). Six of 143 died (4%) vs 362 of 2095 patients (17%, P < .001). Conclusions Recurrent meningitis occurs mainly in patients with ear or sinus infections and cerebrospinal fluid leakage. Predominant causative pathogens are S. pneumoniae and H. influenzae. The disease course is less severe, resulting in lower case fatality compared with nonrecurrent meningitis patients.

Recurrent Meningitis in the Context of an Encephalocele

“…The CSF culture sensitivity decreases when antimicrobials are administered in general [ 14 ]. There was a report of 11-41% of patients clinically suspected of bacterial meningitis with negative CSF cultures [ 6 ]. Hence, a negative CSF culture may be more common in recurrent meningitis.…”

“…The most common organisms that cause meningitis are Streptococcus pneumoniae , Haemophilus influenzae , and Neisseria meningitidis . However, CSF-leakage-associated meningitis is most commonly associated with Streptococcus pneumoniae and Haemophilus influenzae [ 2 , 6 ]. Group B Streptococcus (GBS), otherwise known as Streptococcus agalactiae , is usually the cause of meningitis in neonates and children less than three years old.…”

“…Patients with recurrent bacterial meningitis often have better results than those with nonrecurrent meningitis. This difference may be due to greater awareness of the signs and symptoms seen in meningitis [ 6 ]. Overall, recurrent meningitis remains a critical issue addressed in the clinical setting.…”

Recurrent bacterial meningitis with cerebrospinal fluid rhinorrhea

“…Approximately 5-6% of community acquired bacterial meningitis tends to be recurrent [1]. These recurrent attacks are usually less severe and have more favorable prognosis [1,3]. The most commonly identified predisposing conditions for recurrent bacterial meningitis are ear or sinus infection (37%), CSF leakage (32%), and immunocompromised states (14%) [2].…”

Critical care management of meningitis and encephalitis: an update

“…Despite recent advances, pneumococcal meningitis remains associated with high residual rates of mortality and neurological sequelae [3 ▪▪ ]. Recurrent meningitis was found to be less severe, resulting in lower case fatality compared with nonrecurrent meningitis patients [6].…”