Acute Bacterial Meningitis in Adults -- A Review of 493 Episodes
Open accessAbstract
Background and methods To characterize acute bacterial meningitis in adults, we reviewed the charts of all persons 16 years of age or older in whom acute bacterial meningitis was diagnosed at Massachusetts General Hospital from 1962 through 1988. We included patients who were admitted after initial treatment at other hospitals. Results During the 27-year period, 445 adults were treated for 493 episodes of acute bacterial meningitis, of which 197 (40 percent) were nosocomial. Gram-negative bacilli (other than Haemophilus influenzae) caused 33 percent of the nosocomial episodes but only 3 percent of the community-acquired episodes. In the 296 episodes of community-acquired meningitis, the most common pathogens were Streptococcus pneumoniae (37 percent), Neisseria meningitidis (13 percent), and Listeria monocytogenes (10 percent); these organisms accounted for only 8 percent of the nosocomial episodes. Only 19 of the 493 episodes of meningitis (4 percent) were due to H. influenzae. Nine percent of all patients had recurrent meningitis; many had a cerebrospinal fluid leak. Seizures occurred in 23 percent of patients with community-acquired meningitis, and 28 percent had focal central nervous system findings. Risk factors for death among those with single episodes of community-acquired meningitis included older age (> or = 60 years), obtunded mental state on admission, and seizures within the first 24 hours. Among those with single episodes, the in-hospital mortality rate was 25 p…
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While pleocytosis in the CSF is a sensitive marker of inflammation, several studies have shown cell counts may be normal in both adult and pediatric patients despite a diagnosis of bacterial meningitis.
“While pleocytosis in the CSF is a sensitive marker of inflammation, several studies have shown cell counts may be normal in both adult and pediatric patients despite a diagnosis of bacterial meningitis (21, 22).”
From Multicenter Evaluation of BioFire FilmArray Meningitis/Encephalitis Panel for Detection of Bacteria, Viruses, and Yeast in Cerebrospinal Fluid Specimens (2016) · cites this paper as [22]
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“However, it is noteworthy that pleocytosis was defined at a higher cut-off of�100 leukocytes/uL [3, 23].”
Background
- Authors
- Durand, M. L., Calderwood, S. B., Weber, D. J., Miller, S. I., Southwick, F. S., Caviness, V. S., & Swartz, M. N.
- Affiliations
- Massachusetts General Hospital (US)
- Harvard University (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1993-01-07
- Volume
- 328
- Issue
- 1
- Pages
- 21-28
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2334914963
- Cited by
- 1,344
- References
- 0
- Citations by year
- 2026: 12 · 2025: 29 · 2024: 31 · 2023: 31 · 2022: 36 · 2021: 35 · 2020: 20 · 2019: 43 · 2018: 45 · 2017: 39 · 2016: 42 · 2015: 44 · 2014: 45 · 2013: 52 · 2012: 49
- FWCI
- 20.65
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
- Keywords
- acute bacterial meningitis, adults, nosocomial meningitis, community-acquired meningitis, Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes, Haemophilus influenzae, recurrent meningitis, cerebrospinal fluid leak, seizures, mortality risk factors, case fatality rate, in-hospital mortality
- MeSH terms
- Acute Disease, Adolescent, Adult, Aged, Aged, 80 and over, Boston, Cross Infection, Humans, Middle Aged, Pneumococcal Infections, Recurrence, Risk Factors, Seizures, Gram-Negative Bacterial Infections, Meningitis, Bacterial, Hospital Mortality
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