title: Clinical features, outcome, and meningococcal genotype in 258 adults with meningococcal meningitis: a prospective cohort study.
abstract: 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 (cc11) are related with unfavorable outcome.
authors.affiliation: From Departments of Neurology (SGBH, JdG, MCB, DvdB) and Medical Microbiology (JRP, LS, AvdE), and Netherlands Reference Laboratory of Bacterial Meningitis (JRP, LS, AvdE), Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam; and Department of Neurology (MW), Kennemer Gasthuis, Haarlem, The Netherlands.
authors.forename: Sebastiaan G B
authors.initials: SGB
authors.lastname: Heckenberg
authors.forename: Jan
authors.initials: J
authors.lastname: de Gans
authors.forename: Matthijs C
authors.initials: MC
authors.lastname: Brouwer
authors.forename: Martijn
authors.initials: M
authors.lastname: Weisfelt
authors.forename: Jurgen R
authors.initials: JR
authors.lastname: Piet
authors.forename: Lodewijk
authors.initials: L
authors.lastname: Spanjaard
authors.forename: Arie
authors.initials: A
authors.lastname: van der Ende
authors.forename: Diederik
authors.initials: D
authors.lastname: van de Beek
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001431:Bacteriological Techniques; D004269:DNA, Bacterial / Q000235:genetics; D005260:Female; D005838:Genotype; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008585:Meningitis, Meningococcal / Q000503:physiopathology* / Q000628:therapy; D009345:Neisseria meningitidis / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D017422:Sequence Analysis, DNA; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial