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Clinical Course and Outcome of Community-Acquired Bacterial Meningitis in Cancer Patients

  • Marcin PaciorekEmail author
  • Agnieszka Bednarska
  • Dominika Krogulec
  • Michał Makowiecki
  • Justyna D. Kowalska
  • Dominik Bursa
  • Anna Świderska
  • Joanna Puła
  • Joanna Raczyńska
  • Agata Skrzat-Klapaczyńska
  • Marek Radkowski
  • Urszula Demkow
  • Tomasz Laskus
  • Andrzej Horban
Chapter
Part of the Advances in Experimental Medicine and Biology book series

Abstract

The aim of the study was to determine the course and outcome of bacterial meningitis (BM) in patients with cancer. We retrospectively reviewed files of patients with community-acquired BM, hospitalized in a single neuroinfection center between January 2010 and December 2017. There were 209 patients included in the analysis: 28 had cancer (9 women, 19 men; median age 76, IQR 67–80 years) and 181 were cancer-free (76 women, 105 men; median age 52, IQR 33–65 years) and constituted the control group. Cancer patients, compared with controls, were more likely to present with seizures (25% vs. 8%, p = 0.019), scored higher on the Sequential Organ Failure Assessment, and had a higher mortality rate (32% vs. 13%, p = 0.025). Further, cancer patients were less likely (64% vs. 83%, p = 0.033) to present with two or more out of four clinical manifestations of BM (pyrexia, neck stiffness, altered mental status, and headache) and had a lower white blood cell (WBC) count than non-cancer controls. In multiple regression analysis, the presence of bacterial meningitis in cancer patients was independently associated only with older age (p = 0.001) and lower WBC count (p = 0.007), while mortality was associated with lower Glasgow Coma Score (p = 0.003). In conclusion, bacterial meningitis in cancer patients is characterized by atypical symptoms and high mortality, which requires physicians’ vigilance and a prompt investigation of cerebrospinal fluid in suspected cases. However, multiple regression analysis suggests that differences in clinical presentation and outcomes of bacterial meningitis between cancer and cancer-free patients may also be attributable to other factors, such as age differences.

Keywords

Bacterial meningitis Cancer Community-acquired infection Immunodeficiency Neuroinfection 

Notes

Acknowledgments

MP was supported by grant FRN 004/2019 from the Research Development Foundation of the Hospital for Infectious Diseases in Warsaw and TL by grant 2017/25/B/NZ6/01463 from the National Science Center.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

This study had a retrospective nature consisting of reviewing medical files, with no direct contact with patients; therefore, the requirement of obtaining individual patient consent did not apply.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Marcin Paciorek
    • 1
    Email author
  • Agnieszka Bednarska
    • 1
  • Dominika Krogulec
    • 1
  • Michał Makowiecki
    • 1
  • Justyna D. Kowalska
    • 1
  • Dominik Bursa
    • 1
  • Anna Świderska
    • 1
  • Joanna Puła
    • 1
  • Joanna Raczyńska
    • 1
  • Agata Skrzat-Klapaczyńska
    • 1
  • Marek Radkowski
    • 2
  • Urszula Demkow
    • 3
  • Tomasz Laskus
    • 1
  • Andrzej Horban
    • 1
  1. 1.Department of Adult Infectious DiseasesWarsaw Medical UniversityWarsawPoland
  2. 2.Department of Immunopathology of Infectious and Parasitic DiseasesWarsaw Medical UniversityWarsawPoland
  3. 3.Department of Laboratory Diagnostics and Clinical Immunology of Developmental AgeWarsaw Medical UniversityWarsawPoland

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