Acute bacterial meningitis in adults: an analysis of 95 cases from Saudi Arabia

ABSTRACT

To study the clinical features, laboratory profiles, treatment especially door-to-antibiotic time and outcome in adult patients admitted with acute bacterial meningitis in a tertiary care hospital. Neurology and medical department, King Abdul Aziz Hospital and Oncology Center, Jeddah, Saudi Arabia. Retrospective analysis of 95 consecutive cases of acute bacterial meningitis in adults admitted during study period from January 2000 till June 2005. Clinical and laboratory features, treatment and outcome were analyzed. Total of 95 patients were identified. There were 78[82%] males and 17[18%] females. The mean age was 30 years with range from 14 to 74. Out of the 95 patients, 52[54.7%] cases had meningitis caused by Neisseria meningitides and 16 [16.8%] by Streptococcus pneumoniae. There was one case of meningitis caused by Klebsiella and E. coli each. Latex agglutination [bacterial antigen detection] test was positive in 72 [75%] cases, Gram stain in 40 [42%], and CSF culture in 27 [28.4%]. Triad of fever, headache and neck stiffness or altered conscious level was seen in only 52% of cases. Sixty-five [68%] cases belonged to an African ethnic background and a low socio-economic class. Unfavorable outcome was seen in 19 [20%]. Overall mortality was 6.3% [6 out 95 cases]. Mortality was more with pneumococcal meningitis 12.5% [2out of the 16 cases] compared with meningococcal meningitis 4% [2 out of 52 cases]. Patients, who died, were admitted in deep coma [Glasgow coma scale below 8]. Acute bacterial meningitis remained common and life threatening infection in the community. Neisseria meningitides and Streptococcus pneumoniae are the two most common pathogens for bacterial meningitis in immuno-competent adults. An African ethnic background, poor socioeconomic class and overcrowding were the main predisposing factors. Triad of fever, headache and neck stiffness or altered mental status was seen in about half of the cases