AIM OF THE STUDY: To determine the epidemiological, clinical and laboratory characteristics of adult bacterial meningitis in the Czech Republic, including complications and causes of death. MATERIAL AND METHODS: A longitudinal observational study of adult patients treated for community-acquired or hospital-acquired bacterial meningitis at a specialized unit. Demographic data, clinical signs, cerebrospinal fluid (CSF) test results, bacterial aetiology, complications and clinical outcome were recorded. RESULTS: In 1997-2006, 296 adult patients (128 women, 168 men) with acute bacterial meningitis (age range: 16-85 years; median age: 51 years) were hospitalized. Community- and hospital-acquired meningitis was diagnosed in 278 and 18 cases, respectively. The triad of fever, mental status change and meningism was present in 64 % of patients. Mental status was changed in 74 % of patients, 30 % of patients were comatose. The CSF cytological and biochemical findings were both positive for purulent inflammation in 76 % of patients. The most frequent pathogens were Streptococcus pneumoniae (28 %) and Neisseria meningitidis (25 %). The aetiology was unknown in 24 % of patients. Neurological or systemic complications were revealed in 205 patients (69 %). Fifty-nine patients died (case fatality ratio: 20 %) and 54 patients (18 %) survived with sequelae. Intracranial and systemic complications caused death in 28 patients (47 %) and 31 patients (53 %), respectively. CONCLUSIONS: The study showed that in the majority of patients, both clinical and laboratory signs were sufficiently clear to suggest bacterial meningitis and the need for immediate diagnostics and treatment. It is necessary to increase the identification rate of bacterial meningitis, mainly by means of rigorous implementation of CSF and blood culture in the initial diagnostic procedures as well as increased availability of molecular genetic techniques.

Univerzita Karlova Praha 3 lékarská fakulta Klinika infekcních nemocí

Listeria monocytogenes meningitis in adults: the Czech Republic experience