title: Clinical features and outcome of community-acquired bacterial meningitis in adult patients with liver cirrhosis.
abstract: BACKGROUND
  This study aimed to analyze the clinical features, causative pathogens and therapeutic outcomes of bacterial meningitis in patients with liver cirrhosis.
  
  
  METHODS
  Adult cirrhotic patients with community-acquired bacterial meningitis were evaluated. Clinical data were collected over a 22-year period. For comparison, the clinical features and therapeutic outcomes between patients with and without liver cirrhosis were analyzed.
  
  
  RESULTS
  Liver cirrhosis accounted for 11% (25/217) of the predisposing factors. Significant statistical analysis between the 2 groups (patients with and without liver cirrhosis) included median Glasgow Coma Scale score at presentation, presence of seizure, bacteremia and septic shock. The mean duration between arrival at the emergency room and confirmed diagnosis of bacterial meningitis was 39 hours (range, 2-240 hours). Ten (10/25, 40%) were initially diagnosed with bacterial meningitis, and 6 (6/25, 24%) were initially suggested as having infection of unknown origin. In this study, Klebsiella pneumoniae was the most frequent causative pathogen in patients with liver cirrhosis. The overall case fatality rates for patients with and without liver cirrhosis were 38.5% (74/192) and 64% (16/25), respectively.
  
  
  CONCLUSIONS
  Patients with liver cirrhosis have a more fulminant course with a higher prevalence of disturbed consciousness, bacteremia, seizure and shock. Diagnosis and effective treatment ARE often delayed, resulting in high overall mortality. When patients with liver cirrhosis develop disturbed consciousness, seizures and septicemia, immediate neuroimaging and cerebrospinal fluid studies should be undertaken to determine bacterial meningitis. Early diagnosis and treatment are essential for survival.
authors.affiliation: Departments of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chih-Min
authors.initials: CM
authors.lastname: Su
authors.forename: Wen-Neng
authors.initials: WN
authors.lastname: Chang
authors.forename: Nai-Wen
authors.initials: NW
authors.lastname: Tsai
authors.forename: Chi-Ren
authors.initials: CR
authors.lastname: Huang
authors.forename: Hung-Chen
authors.initials: HC
authors.lastname: Wang
authors.forename: Cheng-Hsien
authors.initials: CH
authors.lastname: Lu
mesh_terms: D000328:Adult; D000368:Aged; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D005260:Female; D006801:Humans; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D008875:Middle Aged