title: Epidemiology and diagnostic testing for meningitis in adults as the meningococcal epidemic declined at Middlemore Hospital.
abstract: OBJECTIVE
  To describe changes in epidemiology and diagnostic techniques for adult meningitis at Middlemore Hospital following the decline of the meningococcal epidemic.
  
  
  METHODS
  Retrospective audit of cases of meningitis from 2000 to 2009.
  
  
  RESULTS
  Microbiologically-confirmed diagnosis (MCD) was established in 296 of 743 episodes (40%), most commonly enterovirus (123/296, 42%), Neisseria meningitidis (43/296, 15%) and Streptococcus pneumoniae (34/296, 11%). N. meningitidis meningitis declined and herpes viruses increased over time, without significant change in overall meningitis case numbers. By 2009, S. pneumoniae constituted a greater proportion of cases than N. meningitidis. Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) and pneumococcal immunochromatographic testing (PICT) increased over time as did the proportion of cases with MCD. CSF Gram stain was positive in 45% (53/118) and CSF culture made MCD in 37% (44/118) of confirmed bacterial episodes (CBE). PCR provided MCD in 59% (26/54) of CBE and 99% (168/170) of viral episodes. CSF PICT was tested in 76% (26/34) of S. pneumoniae meningitis (positive in 92% (24/26).
  
  
  CONCLUSIONS
  As the epidemic waned, local incidence of meningococcal meningitis decreased without significant decreasing meningitis overall. Empiric treatment for meningitis in New Zealand adults should routinely include pneumococcal cover. Increased PCR testing increases MCD in meningitis.
authors.affiliation: Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand. stephen.mcbride@middlemore.co.nz.
authors.forename: Stephen
authors.initials: S
authors.lastname: McBride
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fulke
authors.forename: Hannah
authors.initials: H
authors.lastname: Giles
authors.forename: Mark
authors.initials: M
authors.lastname: Hobbs
authors.forename: Jun
authors.initials: J
authors.lastname: Suh
authors.forename: Vani
authors.initials: V
authors.lastname: Sathyendran
authors.forename: Emily
authors.initials: E
authors.lastname: Thompson
authors.forename: Susan
authors.initials: S
authors.lastname: Taylor
authors.forename: David
authors.initials: D
authors.lastname: Holland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D020803:Encephalitis, Herpes Simplex / Q000175:diagnosis / Q000453:epidemiology; D020804:Encephalitis, Varicella Zoster / Q000175:diagnosis / Q000453:epidemiology; D004769:Enterovirus Infections / Q000175:diagnosis / Q000453:epidemiology; D058872:Epidemics; D005260:Female; D006801:Humans; D008297:Male; D008581:Meningitis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D008585:Meningitis, Meningococcal / Q000175:diagnosis / Q000453:epidemiology; D008586:Meningitis, Pneumococcal / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology; D055815:Young Adult