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Community‐Acquired Meningitis in Older Adults: Clinical Features, Etiology, and Prognostic Factors
Author(s) -
Wang Amy Y.,
Machicado Jorge D.,
Khoury Nabil T.,
Wootton Susan H.,
Salazar Lucrecia,
Hasbun Rodrigo
Publication year - 2014
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13110
Subject(s) - medicine , meningitis , etiology , viral meningitis , epidemiology , pediatrics , cerebrospinal fluid , logistic regression , young adult , bacterial meningitis
Objectives To investigate the epidemiology and outcomes of community‐acquired meningitis in older adults. Design Retrospective study. Setting Participants adults in Houston, Texas, with community‐acquired meningitis hospitalized between January 1, 2005, and January 1, 2010 (N = 619; n = 54, 8.7%, aged ≥65; n = 565 aged <65). Methods An adverse clinical outcome was defined as a Glasgow Outcome Scale score of 4 or less. Results Older adults had higher rates of comorbidities, abnormal neurological and laboratory (serum white blood cell count >12,000/ μ L, and cerebrospinal fluid protein >100 mg/dL) findings ( P < .001), abnormalities on computed tomography and magnetic resonance imaging of the head ( P = .002), and adverse clinical outcomes (ACOs) ( P < .001). The majority of participants (65.8%) had meningitis of unknown etiology. Bacterial meningitis was an infrequent cause of community‐acquired meningitis (7.4%). Of the known causes, bacterial meningitis and West Nile virus were more common in older than younger adults; younger participants more frequently had cryptococcal and viral meningitis. On logistic regression, female sex was predictive of a poor outcome in the older participants ( P = .002), whereas abnormal neurological examination ( P < .001), fever ( P = .01), and a cerebrospinal fluid glucose level less than 45 mg/dL ( P = .002) were significant poor prognostic factors in younger participants. Conclusion Most cases of community‐acquired meningitis are of unknown origin. Older adults are more likely than younger adults to have bacterial meningitis and West Nile virus infection when a cause can be identified. They also have more neurological abnormalities, laboratory and imaging abnormalities, and adverse clinical outcomes.