title: Clinical picture of meningitis in the adult patient and its relationship with age.
abstract: To analyze the clinical characteristics of acute meningitis and their relationship with age in adult patients presenting to the emergency department. We retrospectively investigated consecutive adult patients admitted with a diagnosis of bacterial or viral meningitis from 2002 to 2006. Data about patient's history, symptoms and signs at presentation, etiology and clinical course were collected. To investigate the relationship of clinical presentation with age, we divided patients in four age quartiles (<30 years, between 30 and 36 years, between 37 and 56 years, >56 years). Among the 202 patients considered in the study (mean age 42.8 ± 18.7 years, range 14-90), 162 (80.2%) patients had viral and 40 (19.8%) bacterial meningitis. Specific signs, such as neck stiffness or Kernig or Brudzinski signs, were more common in the first than in the fourth quartile (73.1 vs. 45.7% P = 0.041). Conversely, altered consciousness expressed as Glasgow Coma Scale (GCS) <15 was more frequent in the fourth (80.4%) than in the first (9.6%) quartile (P < 0.001). The linear regression analysis confirmed a significant decrease of GCS with the increasing of patient's age (r = -0.69, P < 0.001). At multivariate analysis, aging was associated with altered level of consciousness (OR 16.7, P < 0.001) independent of viral or bacterial etiology of the presence of comorbidities and of clinical severity (presence of severe sepsis or septic shock). Meningitis presentation largely differs with aging in adult patients. Level of consciousness is frequently altered in the older patients, when other specific signs become more rare, independent of etiology, comorbidities and clinical severity.
authors.affiliation: Emergency Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Magazzini
authors.forename: Peiman
authors.initials: P
authors.lastname: Nazerian
authors.forename: Simone
authors.initials: S
authors.lastname: Vanni
authors.forename: Barbara
authors.initials: B
authors.lastname: Paladini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pepe
authors.forename: Barbara
authors.initials: B
authors.lastname: Casanova
authors.forename: Carolina
authors.initials: C
authors.lastname: Crugnola
authors.forename: Stefano
authors.initials: S
authors.lastname: Grifoni
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D003244:Consciousness Disorders; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008587:Meningitis, Viral / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D012189:Retrospective Studies; D013223:Statistics as Topic; D055815:Young Adult