Infectious causes of acute meningitis among Thai adults in a university hospital

Abstract

© 2020 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases Introduction: Knowing the epidemiology of acute meningitis may guide physicians to promptly administer appropriate empirical therapy, thereby minimizing morbidity and mortality. We aimed to determine the etiology, clinical manifestations, cerebrospinal fluid (CSF) findings, and outcomes of patients with acute meningitis. Methods: We conducted a retrospective cohort study among a total 89 adult (age ≥15 years) patients with acute meningitis. Results: Among them, 48 (53.9%) patients were men; the median age (interquartile range; IQR) was 49 (32.1–63.8) years. The most common coexisting conditions were HIV infection (30%), prednisolone therapy (16.9%), and diabetes mellitus (15.7%). Common clinical presentations were fever (74%), headache (70.8%), and confusion (31.5%). Causes of acute meningitis were Cryptococcus neoformans (37%), bacteria (31.5%), Mycobacterium tuberculosis (27%), and viruses (4.5%). In multivariate logistic regression, predicting factors of acute bacterial meningitis were higher white blood cells (WBCs) in a complete blood count [odds ratio (OR) 1.01 per increase of 100 cells/mm3; 95% confidence interval (CI) 1.00–1.02, p = 0.031], no HIV infection (OR 0.08; 95% CI 0.01–0.72, p = 0.023), and higher serum sodium (OR 1.13; 95% CI 1.01–0.23, p = 0.029). Overall, the median (IQR) duration of hospitalization was 23 (11–29) days. A total 26 (29%) patients had complications, such as septic shock, hydrocephalus, seizure, and brain edema. The in-hospital mortality rate was 7.9%. Conclusions: In this setting, the most common cause of acute meningitis in adults was cryptococcosis followed by tuberculosis. Awareness of local epidemiology and patients’ risk factors are important to initiate appropriate antimicrobial therapy.