title: Bacterial meningitis in solid organ transplant recipients: a population-based prospective study.
abstract: BACKGROUND
  Solid organ transplant (SOT) recipients are at risk of infections of the central nervous system. However, the incidence and clinical course of bacterial meningitis in SOT recipients are unclear. We studied occurrence, disease course, and prognosis of bacterial meningitis in SOT recipients in the Netherlands.
  
  
  METHODS
  All patients with a medical history of solid organ transplantation were selected from our nationwide prospective cohort study on community-acquired bacterial meningitis in patients >16 years old, performed from March 1, 2006 to October 31, 2014. Data on patient history, symptoms and signs on admission, treatment, and outcome were collected prospectively. For transplant recipients, additional information was collected retrospectively.
  
  
  RESULTS
  We identified 6 SOT recipients, all receiving renal transplants. The annual incidence of bacterial meningitis was 7-fold higher (95% confidence interval [CI] 2.94-17.02, P < 0.001) for renal transplant recipients as compared with the general population (9.56 [95% CI 3.98-22.96] vs. 1.35 [95% CI 1.28-1.43] per 100,000 patients per year). One of the 6 patients (17%) presented with the classic presentation of bacterial meningitis (fever, neck stiffness, and change in mental status). Seizures were common, occurring in 33% of patients. Streptococcus pneumoniae and Listeria monocytogenes were identified in 2 patients each, and Escherichia coli and Pseudomonas aeruginosa were both identified once. Four of 6 patients (67%) had an unfavorable functional outcome.
  
  
  CONCLUSIONS
  Bacterial meningitis is a rare but devastating complication of solid organ transplantation. SOT recipients are at high risk for developing meningitis, and recognition of this condition may be difficult, owing to atypical clinical manifestation.
authors.affiliation: Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.|Department of Neurology, Medical Center Haaglanden, The Hague, the Netherlands.
authors.forename: K E B
authors.initials: KE
authors.lastname: van Veen
authors.affiliation: Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: M C
authors.initials: MC
authors.lastname: Brouwer
authors.affiliation: Department of Medical Microbiology Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.|The Netherlands Reference Laboratory for Bacterial Meningitis, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: van der Ende
authors.affiliation: Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. d.vandebeek@amc.uva.nl.
authors.forename: D
authors.initials: D
authors.lastname: van de Beek
mesh_terms: D000328:Adult; D000368:Aged; D017714:Community-Acquired Infections / Q000150:complications / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008089:Listeria monocytogenes / Q000302:isolation & purification; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012189:Retrospective Studies; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D066027:Transplant Recipients / Q000706:statistics & numerical data*
keywords: 
  Streptococcus pneumoniae
  ; bacterial meningitis; incidence; prognosis; renal transplantation; solid organ transplantation