Methods: A retrospective study of adults with community-acquired meningitis hospitalized in Houston, Texas between January 2005 and December 2009. An adverse clinical outcome was defined as a Glasgow Outcome Scale score of 4 or less.
Results: A total of 611 patients were identified, of which 458 (80%) were acute and 153 subacute (20%). The most common etiologies were unknown in 405 (66.3%), viral in 102 (16.7%), bacterial in 48 (7.9%) and fungal in 44 patients (7.2%). Patients with subacute meningitis were more likely to be immunosuppressed, had fungal etiologies, more hypoglycorrachia, higher rates of comorbidities, more abnormal neurological exams and adverse clinical outcomes (ACO) (p<0.05). Patients with an acute presentation were more likely to be treated empirically with intravenous antibiotics and had higher CSF pleocytosis and serum WBC counts (p<0.05). On logistic regression, age > 65 years, and altered mental status were predictive of an adverse clinical outcome in both acute and subacute meningitis; whereas fever and focal neurological deficits were also significant prognostic factors in acute meningitis. (P<0.05).
Conclusion: Acute and subacute meningitis differ in regards to clinical presentations, etiologies, management decisions, and outcomes. Subacute meningitis is associated with more severe disease and has worse clinical outcomes.
R. Hasbun, None