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1403. Infectious Causes of Acute Meningitis Among Thai Adults: A University Hospital Setting
BACKGROUND: Acute meningitis is a medical emergency which needs immediate assessment and treatment. Knowing the epidemiology of acute meningitis may guide the physician for promptly empirical therapy as well as minimize morbidity and mortality. In Thailand, there are few studies regarding acute meni...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809470/ http://dx.doi.org/10.1093/ofid/ofz360.1267 |
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author | Aimbudlop, Kittipat Kiertiburanakul, Sasisopin |
author_facet | Aimbudlop, Kittipat Kiertiburanakul, Sasisopin |
author_sort | Aimbudlop, Kittipat |
collection | PubMed |
description | BACKGROUND: Acute meningitis is a medical emergency which needs immediate assessment and treatment. Knowing the epidemiology of acute meningitis may guide the physician for promptly empirical therapy as well as minimize morbidity and mortality. In Thailand, there are few studies regarding acute meningitis in adults and most of them have not been updated. We aimed to determine etiology, clinical manifestations, cerebrospinal fluid (CSF) findings and outcomes of patients with acute meningitis. METHODS: A retrospective cohort study was conducted among adult (age >15 years) patients with acute meningitis who were treated at Ramathibodi Hospital between 2013 and 2017. The list of the patients was retrieved from the hospital database using the International Classification of Diseases, 10th revision (ICD-10) codes. Comparisons of clinical presentations and laboratory investigations between patients with bacterial meningitis and those with non-bacterial meningitis were analyzed. RESULTS: A total of 89 patients were included. Of all, 48 (53.9%) patients were men and median age (interquartile range; IQR) was 49 (32.1–63.8) years. The most common coexisting condition was HIV infection (30%), receiving prednisolone (16.9%), and diabetes mellitus (15.7%). Causes of acute meningitis were Cryptococcus neoformans (37%), bacteria (31.5%), Mycobacterium tuberculosis (27%), and virus (4.5%). Common clinical presentations were fever (74%), headache (70.8%), and confusion (31.5%). Older age, higher proportion of patients with diabetes, lower proportion of HIV infection, higher median white blood cells (WBCs) in complete blood count (CBC), lower median platelet, higher median aspartate aminotransaminase, higher median alkaline phosphatase, higher median WBCs, and polymorphonuclear neutrophils (PMNs) percentage in CSF were found in patients with acute bacterial meningitis. By multivariate logistic regression, predicting factors of acute bacterial meningitis were WBCs in CBC (OR 1.02 per 100 cells/mm(3) increased; 95% CI 1.01–1.04, P = 0.001), WBCs in CSF (OR 1.04 per 10 cells/mm(3) increased; 95% CI 1.01–1.07, P = 0.012) and PMNs percentage in CSF (OR 1.21 per 5% increased; 95% CI 1.07–1.37, P = 0.002). Overall, the median (IQR) duration of hospitalization was 23 (11–29) days. A total of 26 (29%) patients had a complication, such as septic shock, hydrocephalus, seizure, and brain edema. The mortality rate was 7.9%. CONCLUSION: In this setting, the most common cause of acute meningitis in adults is cryptococcosis. In addition, tuberculosis is not uncommon. Awareness of update epidemiology may guide the physicians to initiate appropriate antimicrobial therapy. DISCLOSURES: All authors: No reported disclosures. |
format | Online Article Text |
id | pubmed-6809470 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-68094702019-10-28 1403. Infectious Causes of Acute Meningitis Among Thai Adults: A University Hospital Setting Aimbudlop, Kittipat Kiertiburanakul, Sasisopin Open Forum Infect Dis Abstracts BACKGROUND: Acute meningitis is a medical emergency which needs immediate assessment and treatment. Knowing the epidemiology of acute meningitis may guide the physician for promptly empirical therapy as well as minimize morbidity and mortality. In Thailand, there are few studies regarding acute meningitis in adults and most of them have not been updated. We aimed to determine etiology, clinical manifestations, cerebrospinal fluid (CSF) findings and outcomes of patients with acute meningitis. METHODS: A retrospective cohort study was conducted among adult (age >15 years) patients with acute meningitis who were treated at Ramathibodi Hospital between 2013 and 2017. The list of the patients was retrieved from the hospital database using the International Classification of Diseases, 10th revision (ICD-10) codes. Comparisons of clinical presentations and laboratory investigations between patients with bacterial meningitis and those with non-bacterial meningitis were analyzed. RESULTS: A total of 89 patients were included. Of all, 48 (53.9%) patients were men and median age (interquartile range; IQR) was 49 (32.1–63.8) years. The most common coexisting condition was HIV infection (30%), receiving prednisolone (16.9%), and diabetes mellitus (15.7%). Causes of acute meningitis were Cryptococcus neoformans (37%), bacteria (31.5%), Mycobacterium tuberculosis (27%), and virus (4.5%). Common clinical presentations were fever (74%), headache (70.8%), and confusion (31.5%). Older age, higher proportion of patients with diabetes, lower proportion of HIV infection, higher median white blood cells (WBCs) in complete blood count (CBC), lower median platelet, higher median aspartate aminotransaminase, higher median alkaline phosphatase, higher median WBCs, and polymorphonuclear neutrophils (PMNs) percentage in CSF were found in patients with acute bacterial meningitis. By multivariate logistic regression, predicting factors of acute bacterial meningitis were WBCs in CBC (OR 1.02 per 100 cells/mm(3) increased; 95% CI 1.01–1.04, P = 0.001), WBCs in CSF (OR 1.04 per 10 cells/mm(3) increased; 95% CI 1.01–1.07, P = 0.012) and PMNs percentage in CSF (OR 1.21 per 5% increased; 95% CI 1.07–1.37, P = 0.002). Overall, the median (IQR) duration of hospitalization was 23 (11–29) days. A total of 26 (29%) patients had a complication, such as septic shock, hydrocephalus, seizure, and brain edema. The mortality rate was 7.9%. CONCLUSION: In this setting, the most common cause of acute meningitis in adults is cryptococcosis. In addition, tuberculosis is not uncommon. Awareness of update epidemiology may guide the physicians to initiate appropriate antimicrobial therapy. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6809470/ http://dx.doi.org/10.1093/ofid/ofz360.1267 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Abstracts Aimbudlop, Kittipat Kiertiburanakul, Sasisopin 1403. Infectious Causes of Acute Meningitis Among Thai Adults: A University Hospital Setting |
title | 1403. Infectious Causes of Acute Meningitis Among Thai Adults: A University Hospital Setting |
title_full | 1403. Infectious Causes of Acute Meningitis Among Thai Adults: A University Hospital Setting |
title_fullStr | 1403. Infectious Causes of Acute Meningitis Among Thai Adults: A University Hospital Setting |
title_full_unstemmed | 1403. Infectious Causes of Acute Meningitis Among Thai Adults: A University Hospital Setting |
title_short | 1403. Infectious Causes of Acute Meningitis Among Thai Adults: A University Hospital Setting |
title_sort | 1403. infectious causes of acute meningitis among thai adults: a university hospital setting |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809470/ http://dx.doi.org/10.1093/ofid/ofz360.1267 |
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