Clinical features, outcome, and meningococcal genotype in 258 adults with meningococcal meningitis - A prospective cohort study

被引:86
作者
Heckenberg, Sebastiaan G. B. [1 ]
de Gans, Jan [1 ]
Brouwer, Matthijs C. [1 ]
Weisfelt, Martijn [4 ]
Piet, Jurgen R. [2 ,3 ]
Spanjaard, Lodewijk [2 ,3 ]
van der Ende, Arie [2 ,3 ]
van de Beek, Diederik [1 ]
机构
[1] Univ Amsterdam, Acad Med Ctr, Dept Neurol, CINIMA, NL-1100 DE Amsterdam, Netherlands
[2] Univ Amsterdam, Acad Med Ctr, CINIMA, Dept Med Microbiol, NL-1100 DE Amsterdam, Netherlands
[3] Univ Amsterdam, Acad Med Ctr, CINIMA, Netherlands Reference Lab Bacterial Meningitis, NL-1100 DE Amsterdam, Netherlands
[4] Kennerner Gasthuis, Dept Neurol, Haarlem, Netherlands
关键词
D O I
10.1097/MD.0b013e318180a6b4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Meningococcal meningitis remains a life-threatening disease. Neisseria meningitidis is the leading cause of meningitis and septicemia in young adults and is a major cause of endemic bacterial meningitis worldwide. The Meningitis Cohort Study was a Dutch nationwide prospective observational cohort study of adults with community-acquired bacterial meningitis, confirmed by Culture of cerebrospinal fluid, from October 1998 to April 2002. Patients underwent a neurologic examination at discharge, and outcome was graded with the Glasgow Outcome Scale. Serogrouping, multi-locus sequence typing, and susceptibility testing of meningococcal isolates were performed. The study identified 258 episodes of meningococcal meningitis in 258 patients. The prevalence of the classical triad of fever, neck stiffness, and change in mental status was low (70/258, 27%). When rash was added to the classical triad, 229 of 258 (89%) patients had at least 2 of 4 signs. Systolic hypotension was associated with rash (22/23 vs. 137/222, p = 0.002) and absence of neck stiffness (6/23 vs. 21/220, p = 0.05). Neuroimaging before lumbar puncture was an important cause of delay of therapy: antibiotics were not initiated before computed tomography (CT) scan in 85% of patients who underwent CT scan before lumbar puncture. Unfavorable outcome occurred in 30 of 258 (12%) patients, including a mortality rate of 7%. Neurologic sequelae occurred in 28 of 238 (12%) patients, particularly hearing loss (8%). Factors associated with sepsis and infection with meningococci of clonal complex 11 (cc 11) are related with unfavorable outcome.
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页码:185 / 192
页数:8
相关论文
共 24 条
[1]   Community-acquired bacterial meningitis: Risk stratification for adverse clinical outcome and effect of antibiotic timing [J].
Aronin, SI ;
Peduzzi, P ;
Quagliarello, VJ .
ANNALS OF INTERNAL MEDICINE, 1998, 129 (11) :862-869
[2]   EARLY TREATMENT WITH PARENTERAL PENICILLIN IN MENINGOCOCCAL DISEASE [J].
CARTWRIGHT, K ;
REILLY, S ;
WHITE, D ;
STUART, J .
BMJ-BRITISH MEDICAL JOURNAL, 1992, 305 (6846) :143-147
[3]   Current concepts - Corticosteroid insufficiency in acutely ill patients [J].
Cooper, MS ;
Stewart, PM .
NEW ENGLAND JOURNAL OF MEDICINE, 2003, 348 (08) :727-734
[4]   Dexamethasone in adults with bacterial meningitis. [J].
de Gans, J ;
van de Beek, D .
NEW ENGLAND JOURNAL OF MEDICINE, 2002, 347 (20) :1549-1556
[5]   Protection from routine vaccination at the age of 14 months with meningococcal serogroup C conjugate vaccine in the Netherlands [J].
de Greeff, SC ;
de Melker, HE ;
Spanjaard, L ;
Schouls, LM ;
van DerEnde, A .
PEDIATRIC INFECTIOUS DISEASE JOURNAL, 2006, 25 (01) :79-80
[6]   PROSPECTIVE EVALUATION OF HEARING IMPAIRMENT AS A SEQUELA OF ACUTE BACTERIAL-MENINGITIS [J].
DODGE, PR ;
DAVIS, H ;
FEIGIN, RD ;
HOLMES, SJ ;
KAPLAN, SL ;
JUBELIRER, DP ;
STECHENBERG, BW ;
HIRSH, SK .
NEW ENGLAND JOURNAL OF MEDICINE, 1984, 311 (14) :869-874
[7]  
HAHNE SJM, 2006, BMJ-BRIT MED J, V332, P1283, DOI DOI 10.1136/BMJ.332.7553.1299
[8]   Parenteral penicillin for children with meningococcal disease before hospital admission: case-control study [J].
Harnden, A ;
Ninis, N ;
Thompson, M ;
Perera, R ;
Levin, M ;
Mant, D ;
Mayon-White, R .
BRITISH MEDICAL JOURNAL, 2006, 332 (7553) :1295-1297
[9]   Early management of suspected bacterial meningitis and meningococcal septicaemia in immunocompetent adults - second edition [J].
Heyderman, RS .
JOURNAL OF INFECTION, 2005, 50 (05) :373-374
[10]   mlstdbNet - distributed multi-locus sequence typing (MLST) databases [J].
Jolley, KA ;
Chan, MS ;
Maiden, MCJ .
BMC BIOINFORMATICS, 2004, 5 (1)