title: Community-acquired bacterial meningitis in adults with cancer or a history of cancer.
abstract: OBJECTIVE
  To study the incidence, clinical presentation, causative bacteria, and outcome of community-acquired bacterial meningitis in adults with cancer.
  
  
  METHODS
  We evaluated incidence and characteristics of patients with cancer included in a nationwide prospective cohort study of adults with community-acquired meningitis performed in the Netherlands from March 1, 2006, to September 31, 2014. All patients underwent a neurologic examination at hospital discharge, and outcome was graded using the Glasgow Outcome Scale.
  
  
  RESULTS
  Active cancer was identified in 68 of 1,351 episodes (5%) and a history of cancer in 87 (6%). The annual incidence of community-acquired bacterial meningitis was 2.71-fold (95% confidence interval [CI] 1.68-4.36, p < 0.001) increased for patients with cancer compared to patients without cancer in 2010, and 3.52-fold (95% CI 2.16-5.73, p < 0.001) in 2013. The clinical presentation of bacterial meningitis in patients with cancer compared to patients without cancer was similar. Patients with active cancer presented with lower leukocyte count in blood (12.1 × 10(9) cells/L vs 17.3 × 10(9) cells/L, p < 0.001) and CSF (670 cells/mm(3) vs 2,567 cells/mm(3), p < 0.001) and were more likely to be infected with Listeria monocytogenes (21% vs 5%, p < 0.001) than patients without cancer. Active cancer was identified as an independent risk factor for unfavorable outcome in bacterial meningitis (odds ratio 1.85, 95% CI 1.09-3.13).
  
  
  CONCLUSIONS
  One of 8 patients with community-bacterial meningitis was identified to have a history of cancer and cancer was considered active in half of these patients. Patients with active cancer present with lower CSF leukocyte counts, are more likely to be infected with L monocytogenes, and are at high risk of unfavorable outcome.
authors.affiliation: From the Departments of Neurology (J.M.C., M.C.B., D.v.d.B.), Medical Microbiology (A.v.d.E.), and the Netherlands Reference Laboratory for Bacterial Meningitis (A.v.d.E.), Academic Medical Center, Center of Infection and Immunity Amsterdam, the Netherlands.
authors.forename: Joost M
authors.initials: JM
authors.lastname: Costerus
authors.affiliation: From the Departments of Neurology (J.M.C., M.C.B., D.v.d.B.), Medical Microbiology (A.v.d.E.), and the Netherlands Reference Laboratory for Bacterial Meningitis (A.v.d.E.), Academic Medical Center, Center of Infection and Immunity Amsterdam, the Netherlands.
authors.forename: Matthijs C
authors.initials: MC
authors.lastname: Brouwer
authors.affiliation: From the Departments of Neurology (J.M.C., M.C.B., D.v.d.B.), Medical Microbiology (A.v.d.E.), and the Netherlands Reference Laboratory for Bacterial Meningitis (A.v.d.E.), Academic Medical Center, Center of Infection and Immunity Amsterdam, the Netherlands.
authors.forename: Arie
authors.initials: A
authors.lastname: van der Ende
authors.affiliation: From the Departments of Neurology (J.M.C., M.C.B., D.v.d.B.), Medical Microbiology (A.v.d.E.), and the Netherlands Reference Laboratory for Bacterial Meningitis (A.v.d.E.), Academic Medical Center, Center of Infection and Immunity Amsterdam, the Netherlands. d.vandebeek@amc.uva.nl.
authors.forename: Diederik
authors.initials: D
authors.lastname: van de Beek
mesh_terms: D000368:Aged; D015984:Causality; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007958:Leukocyte Count / Q000706:statistics & numerical data; D008297:Male; D008487:Medical History Taking / Q000706:statistics & numerical data; D008584:Meningitis, Listeria / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000382:microbiology; D009426:Netherlands / Q000453:epidemiology; D018570:Risk Assessment