Pneumococcal meningitis in adults. a study of 141 episodes
Fernández-Viladrich, P.; Buenaventura, I.; Gudiol, F.; Gallofré, M.; Rufí, G.; Butí, M.; Pallarés, R.; Ariza, J.
Medicina Clinica 87(14): 569-574
1986
ISSN/ISBN: 0025-7753 PMID: 3784675 Document Number: 270464
141 episodes of pneumococcal meningitis seen during the 1977-1984 period were analyzed. Mean age of the patients was 47 years. 34.5% had some underlying condition, particularly chronic alcoholism or diabetes mellitus. The major sources of meningitis were acute otitis media in 35%, traumatic pericranial CSF fistula in 31% and pneumonia in 13%; in the remaining 20% the source of meningitis was unknown. 92% had impairment of the level of consciousness, and 50% had focal neurologic signs. Cranial computed tomography, performed during the early days of the clinical course in 58 patients ruled out cerebral abscess. Gram stain and culture of CSF were positive in 86% and 98% of cases, respectively, and blood culture was positive in 75%. Cure was achieved in 94 patients (in 3 of them after a relapse); in 17 residual neurologic deficit was present. Mortality rate was 32%, and it was similar in both institutions. After an analysis of the mechanisms leading to death and the risk factors for the latter, the following points are emphasized: the need of early and initially effective antibiotic therapy, the mandatory character of antibiotic susceptibility studies, and the importance of early and vigorous therapy of cerebral edema.