title: Outcome of fulminant bacterial meningitis in adult patients.
abstract: OBJECTIVE
  The objective of our study was to identify neurological factors associated with poor outcome in adult patients with fulminant bacterial meningitis.
  
  
  METHODS
  This was a retrospective review of consecutive adult patients with fulminant bacterial meningitis, defined as meningitis causing coma within 24-48 h of hospitalization, at Mayo Clinic Rochester between January 2000 and November 2010. Functional status was assessed at discharge and upon last follow-up using the modified Rankin scale (mRS). The primary end-point was death or new major disability (increase of >2 on the mRS) at last follow-up.
  
  
  RESULTS
  Thirty-nine patients were identified. Encephalopathy (44%), coma (28%), focal seizures (3%) or a combination of these (26%) were present on admission. The most common pathogen was Streptococcus pneumoniae (57%). All patients were treated with broad spectrum antibiotics and 51% received steroids. Serious systemic complications were seen in 23 patients. Sixteen patients (41%) died during hospitalization. Median mRS at hospital discharge for surviving patients was 3; four patients had new major disability with a mean follow-up of 11 months. Predictors of death or new major disability included lower Glasgow Coma Scale score at nadir [P = 0.002; age- and sex-adjusted odds ratio (OR) 0.46, 95% confidence interval (CI) 0.28-0.48], longer duration of symptoms before hospitalization (P = 0.045; adjusted OR 2.34, 95% CI 1.02-5.37), abnormal head imaging at presentation (P = 0.008; adjusted OR 9.40, 95% CI 1.78-49.6) and use of intracranial pressure monitoring (P = 0.010, adjusted OR 51.0, 95% CI 2.51-1036).
  
  
  CONCLUSIONS
  Many adult patients who survive hospitalization are able to regain their pre-morbid level of function. Aggressive management of bacterial meningitis is justified even in comatose adult patients.
authors.affiliation: Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Muralidharan
authors.forename: F J
authors.initials: FJ
authors.lastname: Mateen
authors.forename: A A
authors.initials: AA
authors.lastname: Rabinstein
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D015600:Glasgow Coma Scale; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy*; D008875:Middle Aged; D059906:Neuroimaging; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: bacteria; coma; immunosuppression; meningitis; treatment