The Etiological Role of Parameningeal Infections in Adult Patients with Community-Acquired Acute Bacterial Meningitis in Eastern Turkey

Objective: To determine the etiological role of parameningeal infections in communityacquired acute bacterial meningitis in adults. Material and Methods: This prospective study included 69 (45 males, 24 females; mean age 39.2 +/- 20.4 years, range: 14-76 years) patients with community acquired acute bacterial meningitis hospitalized in the Department of Infectious Diseases and Clinical Microbiology, Ataturk University Medical School Hospital between December 2002 and December 2006. The diagnosis was based on the clinical pictures and physical examination, laboratory, and radiological findings. Results: Fifty-five patients (79.7%) had at least one underlying medical condition; 55.1% had one or more parameningeal infections and 24.6% had another underlying disease. Among the underlying medical conditions, paranasal sinusitis and otitis media were the most common; 23.2% and 18.8%, respectively. The maxillary sinuses were the most common focus for sinusitis. Of the patients, 15.9% died during hospitalization. Five of the survivors (8.6%) had several complications and 3 (5.1%) had permanent neurological sequelae. The mean age of the fatal group (51.4 +/- 21.6 years) was higher than that of the non-fatal group (36.9 +/- 19.4 years, p=0.03). In univariate analysis, significant risk factors for mortality were older age, female gender, and deteriorated consciousness level. Underlying medical conditions had no effect on mortality. In stepwise logistic regression analysis, only the initial consciousness level and female gender were independently associated with mortality. Conclusion: Parameningeal infections are the major predisposing factor for community-acquired bacterial meningitis in adults. In all cases of adult bacterial meningitis, parameningeal infections or other underlying conditions should be investigated carefully and should be managed properly.