Infectious meningitis at the University Hospital of the West Indies. Review of clinical and laboratory findings (1965-1980)

ABSTRACT

A retrospective study is reported on 215 cases of infectious meningitis seen during a 16-year period (1965-1980) at the University Hospital of the West Indies, Kingston, Jamaica. A detailed analysis was made of the aetiology, epidemiology, signs and symptoms, associated conditions, laboratory investigations, treatment regimes as well as outcome. The most common causative organism of bacterial meningitis was Streptococcus pneumoniae (29.3 percent), being seen in all age groups except in neonates. Haemophilus influenzae (23 percent) was the most frequent cause in pre-school children. Unusual pathogens constituted a major group of bacterial meningitis, accounting for 34 (21.3 percent). Of 11 neonates recorded, 7 (63.6 percent) belonged to this latter group. There were 48 (22.3 percent) cases of aseptic meningitis, 5 tuberculous and 2 cryptococcal. The overall mortality was 14.4 percent. The fatality rate in pneumococcal meningitis was 25.5 percent whereas in that caused by Haemophilus it was 2.7 percent. No deaths were recorded in the aseptic group. The gram stain was useful in 65 percent of cases of bacterial meningitis. One third of aseptic cases had 50 percent or more of neutrophils in the CSF. The highest CSF white cell count in aseptic and bacterial meningitis was 2,176 and 36,000 cells/mm3, respectively. The highest CSF protein level in bacterial and aseptic meningitis was 774 mg/100 ml and 150 mg/ml, respectively. Because of the high incidence of unusual pathogens, there is a need for a modified approach to initial antibiotic treatment bearing in mind the multiple antibiotic-resistant strains that are frequently encountered (AU)