title: Community-acquired bacterial meningitis in older people.
abstract: OBJECTIVE
  To describe clinical features of bacterial meningitis in older people.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Hospitals in the Netherlands.
  
  
  METHODS
  Patients aged over 16 with community-acquired bacterial meningitis, confirmed using cerebrospinal fluid culture.
  
  
  METHODS
  Data were collected prospectively. The cohort was dichotomized with respect to age (>or=60 vs 17-59).
  
  
  RESULTS
  Two hundred fifty-seven of 696 episodes of community-acquired bacterial meningitis (37%) occurred in elderly patients and 439 (63%) in younger adults. Older people more often presented with the triad of fever, neck stiffness, and altered mental status than younger adults (58% vs 36%; P<.001). In older people, meningitis was due to Streptococcus pneumoniae in 176 episodes (68%). In younger adults, Neisseria meningitidis was the most common pathogen, responsible for 221 episodes (50%). Elderly patients more often developed complications than younger adults (72% vs 57%; P<.001), which resulted in a higher mortality rate (34% vs 13%; P<.001). Older people tended to die more often from cardiorespiratory failure (25% vs 11%; P=.06), whereas younger adults more often died from brain herniation (23% vs 2%; P=.004).
  
  
  CONCLUSIONS
  Elderly patients with bacterial meningitis often present with classic symptoms of bacterial meningitis. Bacterial meningitis within this age group is predominantly due to S. pneumoniae and is associated with high morbidity and mortality rates. Whereas older people die frequently of cardiorespiratory failure, younger adults more often die of brain herniation.
authors.affiliation: Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands. M.Weisfelt@amc.uva.nl
authors.forename: Martijn
authors.initials: M
authors.lastname: Weisfelt
authors.forename: Diederik
authors.initials: D
authors.lastname: van de Beek
authors.forename: Lodewijk
authors.initials: L
authors.lastname: Spanjaard
authors.forename: Johannes B
authors.initials: JB
authors.lastname: Reitsma
authors.forename: Jan
authors.initials: J
authors.lastname: de Gans
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000150:complications / Q000401:mortality / Q000628:therapy; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000401:mortality / Q000628:therapy; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000401:mortality / Q000628:therapy; D006801:Humans; D016920:Meningitis, Bacterial / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008875:Middle Aged; D009426:Netherlands; D012307:Risk Factors; D016896:Treatment Outcome