Abstract
To analyze the clinical characteristics of acute meningitis and their relationship with age in adult patients presenting to the emergency department. We retrospectively investigated consecutive adult patients admitted with a diagnosis of bacterial or viral meningitis from 2002 to 2006. Data about patient’s history, symptoms and signs at presentation, etiology and clinical course were collected. To investigate the relationship of clinical presentation with age, we divided patients in four age quartiles (<30 years, between 30 and 36 years, between 37 and 56 years, >56 years). Among the 202 patients considered in the study (mean age 42.8 ± 18.7 years, range 14–90), 162 (80.2%) patients had viral and 40 (19.8%) bacterial meningitis. Specific signs, such as neck stiffness or Kernig or Brudzinski signs, were more common in the first than in the fourth quartile (73.1 vs. 45.7% P = 0.041). Conversely, altered consciousness expressed as Glasgow Coma Scale (GCS) <15 was more frequent in the fourth (80.4%) than in the first (9.6%) quartile (P < 0.001). The linear regression analysis confirmed a significant decrease of GCS with the increasing of patient’s age (r = −0.69, P < 0.001). At multivariate analysis, aging was associated with altered level of consciousness (OR 16.7, P < 0.001) independent of viral or bacterial etiology of the presence of comorbidities and of clinical severity (presence of severe sepsis or septic shock). Meningitis presentation largely differs with aging in adult patients. Level of consciousness is frequently altered in the older patients, when other specific signs become more rare, independent of etiology, comorbidities and clinical severity.
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References
Kernig W (1884) Ueber ein Wening bemerkers meningitis symptom. Berl Klin Wochenschr 21:829–832
Brudzinski J (1909) Un signe noveau sur les membres interieurs dans les meningites chez les enfants (sugne dela noque). Arch Med Enfants 12:754–752
Thomas KE, Hasbun R et al (2002) The diagnostic accuracy of Kernig’s sign Brudzinski’s sign and nucal rigidity in adults with suspected meningitis. Clin Infect Dis 35:46–51
Attia J, Hatala R et al (1999) Does this adult patient have acute meningitis? JAMA 281:175–181
Miner JR, Heegaard W et al (2001) Presentation time to antibiotics and mortality of patients with bacterial meningitis at an urban county medical center. J Emerg Med 21:387–392
Puxty JAH, Fox RA et al (1983) The frequency of physical signs usually attributed to meningeal irritation in elderly patients. J Am Geriatric Soc 31:590–592
Choi C (2001) Bacterial meningitis in aging adult. CID 33:1380–1385
Mandell GL, Bennett JL et al (2009) Mandell and Douglas and Bennett’s principles and practice of infectious diseases. Chap 84. Churchill Livingstone
Goldman L, Ausiello D et al (2004) Cecil textbook of medicine XXIII edn. Chap 437
Durand ML, Calderwood SB et al (1993) Acute bacterial meningitis in adults. NEJM 328:2128
Van de Beek D, deGans J et al (2004) Clinical Features and prognostic factors in adults with bacterial meningitis. NEJM 351:1849–1859
Van de Beek D, de Gans J et al (2006) Community acquired bacterial meningitis in adults. NEJM 354:44–53
Flores Cordeo JM, Amaya-Villar R et al (2003) Acute community acquired bacterial meningitis in adults admitted to the intensive care unit: clinical manifestations management and prognostic factors. Intensive Care Med 29:1967–1973
Aronin SI, Peduzzi P et al (1998) Community acquired bacterial meningitis: risk stratification for adverse clinical outcome and effect of antibiotic timing. Ann Int med 129:862–869
Nicoletti R, Verani P et al (1991) Central nervous system involvement during infection by phlebovirus toscana of residents in natural foci in central Italy (1977–1988). Am J Trop Med Hyg 45:429–434
Brivet G, Ducuing S et al (2005) Accuracy of clinical presentation for differentiating bacterial from viral meningitis in adults: a multivariate approach. Intensive Care Med 31:1654–1660
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Magazzini, S., Nazerian, P., Vanni, S. et al. Clinical picture of meningitis in the adult patient and its relationship with age. Intern Emerg Med 7, 359–364 (2012). https://doi.org/10.1007/s11739-012-0765-1
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DOI: https://doi.org/10.1007/s11739-012-0765-1