Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Feb 27:13:108.
doi: 10.1186/1471-2334-13-108.

The spectrum of acute bacterial meningitis in elderly patients

Pere Domingo  1 , Virginia Pomar, Natividad de Benito, Pere Coll
Affiliations

The spectrum of acute bacterial meningitis in elderly patients

Pere Domingo et al. BMC Infect Dis. .

Abstract

Background: We conducted a prospective, observational study in Barcelona to determine the epidemiology, clinical features, and outcome of elderly patients with acute bacterial meningitis (ABM) compared with younger adults.

Methods: During 1982-2010, all patients with ABM were prospectively evaluated. There were two groups: I (15-64 years) and II (≥ 65 years). All patients underwent clinical examination on admission and at discharge following a predefined protocol.

Results: We evaluated 635 episodes of ABM. The incidence was 4.03/100,000 (Group I) and 7.40 /100,000 inhabitants/year (Group II) (RR = 1.84; 95%CI: 1.56-2.17, P < 0.0001). Elderly patients had co-morbid conditions more frequently (P < 0.0001) and more frequently lacked fever (P = 0.0625), neck stiffness (P < 0.0001) and skin rash (P < 0.0001), but had an altered level of consciousness more often (P < 0.0001). The interval admission-start of antibiotic therapy was longer for elderly patients (P < 0.0001). Meningococcal meningitis was less frequent in elderly patients (P < 0.0001), whereas listerial (P = 0.0196), gram-negative bacillary (P = 0.0065), and meningitis of unknown origin (P = 0.0076) were more frequent. Elderly patients had a higher number of neurologic (P = 0.0009) and extra-neurologic complications (P < 0.0001). The overall mortality ratio was higher in elderly patients (P < 0.0001).

Conclusions: Elderly people are at higher risk of having ABM than younger adults. ABM in the elderly presents with co-morbid conditions, is clinically subtler, has a longer interval admission-antibiotic therapy, and has non-meningococcal etiology. It is associated with an earlier and higher mortality rate than in younger patients.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Survival curves for adult patients with acute bacterial meningitis according to age (P = 0.007).
See this image and copyright information in PMC

References

    1. Morris SK, Moss WJ, Halsey N. Haemophilus influenzae type b conjugate vaccine use and effectiveness. Lancet Infect Dis. 2008;8:435–443. doi: 10.1016/S1473-3099(08)70152-X. - DOI - PubMed
    1. Thigpen MC, Whitney CG, Messonnier NE, Zell ER, Lynfield R, Hadler JL, Harrison LH, Farley MM, Reingold A, Bennett NM, Craig AS, Schaffner W, Thomas A, Lewis MM, Scallan E, Schuchat A. Bacterial meningitis in the United States, 1998–2007. N Engl J Med. 2011;364:2016–2025. doi: 10.1056/NEJMoa1005384. - DOI - PubMed
    1. Verani JR, Schrag SJ. Group B streptococcal disease in infants: progress in prevention and continued challenges. Clin Perinatol. 2010;37:375–392. doi: 10.1016/j.clp.2010.02.002. - DOI - PMC - PubMed
    1. Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol. 2010;23:467–492. doi: 10.1128/CMR.00070-09. - DOI - PMC - PubMed
    1. Meningococcal Disease Surveillance Group. Meningococcal disease: secondary attack rate and chemoprophylaxis in the United States, 1974. JAMA. 1976;235:261–265. - PubMed

Publication types

Substances

LinkOut - more resources