title: Spectrum of complications and mortality of bacterial meningitis: an experience from a developing country.
abstract: OBJECTIVE
  The aim of this study was to obtain data on predisposing factors, causative organisms and their associated mortality and complications related to acute bacterial meningitis.
  
  
  METHODS
  The chart review of all patients in whom acute bacterial meningitis was diagnosed at The Aga Khan University Hospital from January 1995 through December 2001.
  
  
  RESULTS
  One hundred ninety-four patients were included in study. There were 146 males and 48 females. The mean age of our study population was 41 +/- 12.3 years. One hundred and ninety (97.9%) patients had community-acquired meningitis; only 4 (2.0%) patients developed meningitis nosocomially. The two most common predisposing factors were diabetes mellitus (13.9%) and otitis media (7.7%) among all 194 patients. A significant proportion of patients with complications had diabetes mellitus (24.6%, p < 0.001). CSF and blood cultures were positive in 53 (27.3%) and 42 (21.6%) patients respectively; there was no statistical difference found. The most common organisms isolated were Streptococcus pneumoniae in 35 (36.8%) patients followed by Neisseria meningitides in 30 (31.5%) patients. Approximately 68% of positive cultures yielded S. pneumoniae and N. meningitides (p < 0.0001). The overall mortality rate was 22.1%. The mortality rate for Streptococcus pneumoniae was 17.1%. The highest mortality was observed in patients with Pseudomonal meningitis where all four patients expired followed by mortality rate of 85.7% in Escherichia coli afflicted patients (p < 0.001). Complications occurred in 73 (37.6%) patients with persistent complications in 31 (42.4%) patients. Complications resolved in 34 (46.5%) patients. The most common complications were seizures (12.8%) and cranial nerve palsies (11.3%). Seizures were more likely to occur in older patients (p < 0.05) whereas hydrocephalus was more common in younger patients (p < 0.05).
  
  
  CONCLUSIONS
  Bacterial Meningitis remains a serious disease associated with substantial morbidity and mortality. Most cases are community acquired with S. Pneumoniae being the most common pathogen. Old age, diabetes mellitus, a positive culture, seizures as a complication and late stage in the disease are the important predictors of a poor outcome.
authors.affiliation: Department of Medicine, Aga Khan University, Karachi.
authors.forename: M A
authors.initials: MA
authors.lastname: Rabbani
authors.forename: A A
authors.initials: AA
authors.lastname: Khan
authors.forename: S S
authors.initials: SS
authors.lastname: Ali
authors.forename: B
authors.initials: B
authors.lastname: Ahmad
authors.forename: S M
authors.initials: SM
authors.lastname: Baig
authors.forename: M A
authors.initials: MA
authors.lastname: Khan
authors.forename: M
authors.initials: M
authors.lastname: Wasay
mesh_terms: D000328:Adult; D015984:Causality; D005260:Female; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality*; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D012189:Retrospective Studies