title: Meningitis and Meningoencephalitis among Israel Defense Force Soldiers: 20 Years Experience at the Hadassah Medical Centers.
abstract: BACKGROUND
  Meningitis and meningoencephalitis pose major risks of morbidity and mortality.
  
  
  OBJECTIVE
  To describe 20 years of experience treating infections of the central nervous system in Israel Defense Force (IDF) soldiers, including the common presentations, pathogens and sequelae, and to identify risk groups among soldiers.
  
  
  METHODS
  All soldiers who were admitted to the Hadassah University Medical Center (both campuses: Ein Kerem and Mt. Scopus) due to meningitis and meningoencephalitis from January 1993 to January 2014 were included in this retrospective study. Clinical, laboratory and radiologic data were reviewed from their hospital and army medical corps files. Attention was given to patients' military job description, i.e., combat vs. non-combat soldier, soldiers in training, and medical personnel.
  
  
  RESULTS
  We identified 97 cases of suspected meningitis or meningoencephalitis. Six were mistakenly filed and these patients were found to have other disorders. Four soldiers were diagnosed with epidural abscess and five with meningitis due to non-infectious in flammatory diseases. Eighty-two soldiers in active and reserve duty had infectious meningitis or meningoencephalitis. Of these, 46 (56.1%) were combat soldiers and 31 (37.8%) non-combat; 20 (29.2%) were soldiers in training, 10 (12.2%) were training staff and 8 (9.8%) were medical staff. The main pathogens were enteroviruses, Epstein-Barr virus an d Neisseria meningitidis.
  
  
  CONCLUSIONS
  In our series, soldiers in training, combat soldiers and medical personnel had meningitis and meningoencephalitis more than other soldiers. Enteroviruses are highly infectious pathogens and can cause outbreaks. N. meningitidis among IDF soldiers is still a concern. Early and aggressive treatment with steroids should be considered especially in robust meningoencephalitis cases.
authors.forename: Yoav Y
authors.initials: YY
authors.lastname: Pikkel
authors.forename: Tamir
authors.initials: T
authors.lastname: Ben-Hur
authors.forename: Ruth
authors.initials: R
authors.lastname: Eliahou
authors.forename: Asaf
authors.initials: A
authors.lastname: Honig
mesh_terms: D004770:Enterovirus / Q000302:isolation & purification; D005260:Female; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008581:Meningitis / Q000453:epidemiology* / Q000382:microbiology; D008590:Meningoencephalitis / Q000453:epidemiology* / Q000382:microbiology; D008889:Military Personnel; D009345:Neisseria meningitidis / Q000302:isolation & purification; D012189:Retrospective Studies; D055815:Young Adult