Characteristics and outcome of spontaneous bacterial meningitis in patients with cancer compared to patients without cancer

Virginia Pomar, Natividad Benito, Joaquin López-Contreras, Pere Coll, Mercedes Gurguí, Pere Domingo

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3 Citations (Scopus)

Abstract

Copyright © 2017 the Author(s). In cancer patients, who are frequently immunocompromised, bacterial meningitis (BM) can be a severe complication, with a different presentation, etiology, and course, compared to patients without cancer. Our objective is to compare the characteristics and outcomes of BM in patients with and without cancer. A single-center, prospective observational cohort study, conducted between 1982 and 2012, in a tertiary university hospital in Barcelona (Spain). The main outcome measure is in-hospital mortality. We evaluated 659 episodes of BM; 97 (15%) had active cancer. Patients with malignancies were older (median 63 (interquartile range [IQR] 24) vs 52 [IQR 42] years, P<.001) and more often had a Charlson comorbidity score of ≥3 (51% vs 11%, P<.001). The classic meningitis triad (35% vs 50%, P=.05), fever (91% vs 96%, P=.03), neck stiffness (58% vs 78%, P<.001), headache (63% vs 77%) P=.003), and rash (7% vs 30%, P<.001) were less frequent. There was a longer interval between admission and antibiotic therapy (median 5 [IQR 14] vs 3 [IQR 6] hours, P<.001). Listeria meningitis was the commonest cause of BM (29%) and was more frequent in cancer than noncancer (8%, P<.001) patients, whereas meningococcal meningitis was much less frequent (4% vs 36%, P<.001). Overall mortality was higher in patients with cancer (31% vs 16%, P<.001), although cancer was not associated with an unfavorable outcome in the multivariate analysis (odds ratio 1.825, P=.07). Patients with meningitis and cancer are older and have more subtle clinical manifestations than patients without cancer. Listeria monocytogenes is the predominant pathogen and mortality is higher in cancer patients.
Original languageEnglish
Article numbere6899
JournalMedicine (United States)
Volume96
Issue number19
DOIs
Publication statusPublished - 1 May 2017

Keywords

  • bacterial infection of the central nervous system
  • bacterial meningitis
  • cancer
  • spontaneous meningitis

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