A Prospective Study on the Clinical Profile and Outcome of Meningoencephalitis in Adults in a South Indian Tertiary Care Centre

Abstract

IntroductionMeningitis is a clinical syndrome characterised by infl ammation of the meninges surrounding the brain and the spinal cord. The classic triad of meningitis consists of fever, headache and neck stiffness. 1 Meningitis can be of infective or noninfective aetiology, occurring in any age group, with extremes of age being the most severely affected. The immune-compromised state also has high mortality and morbidity. The overall case fatality rate of bacterial meningitis in adult patients is around 30%. [2][3][4] Although encephalitis by definition involves the brain parenchyma, it may also involve the meninges as well, which is termed as 'meningoencephalitis'. From an epidemiologic and pathophysiologic perspective, encephalitis is distinct from meningitis, though on clinical evaluation both can coexist. The clinical presentation is encephalopathy with diffuse or focal neurological symptoms, including behavioural and personality changes, decreased level of consciousness, neck pain/ stiffness, photophobia, lethargy, generalised or focal seizures, acute confusion or amnesic states, and fl accid paralysis. 5 Organisms responsible for bacterial meningitis are Streptococcus pneumoniae, Neisseria meningitis, Group B streptococci, Listeria monocytogens and Haemophilus infl uenza type b. Most patients recover completely if appropriate antibiotic therapy is instituted promptly. Mycobacterium tuberculosis is another major cause, especially in developing countries. Tuberculous meningitis is a critical disease in terms of fatal outcome and permanent sequelae, requiring rapid diagnosis and treatment. 6 The term aseptic meningitis is used for all types of infl ammation of the brain meninges not caused by pusproducing bacteria. It is usually a benign syndrome. Viral and aseptic meningitis are terms used interchangeably as, not only viruses are a major cause, other noninfective causes are equally attributable to the development of meningitis. Worldwide causes of viral meningitis include enterovirus, herpes, mumps, measles and HIV, with enterovirus being the most common cause of viral meningitis.In the emergency setting differentiating bacterial meningitis from other causes, such as fungal, tuberculous, viral, Background Although there are numerous studies on meningitis and encephalitis separately, literature on meningoencephalitis is sparse. In this study we analysed the clinical pro le of meningoencephalitis and its clinical outcome.Methods Fifty adults diagnosed with meningoencephalitis from July 2014 to July 2015 in a tertiary care hospital in South India were studied prospectively and their clinical presentation, aetiology and outcome were analysed.Results Among 50 patients, 33 (66%) were male; 39 (78%) were <50 years of age. Fever was the most common presenting symptom in 41 out of 50 patients (82%), followed by headache (74%) and altered sensorium (62%); only 18 patients (36%) had all three classical symptoms. Twenty-eight out of 50 patients (56%) did not have neck stiffness. A majority of patients had acute-to-subac...

Meningoencephalitis in Adults

“…2 Clearly, more work needs to be carried out on this front to elucidate the mechanisms behind this devastating illness. Petchiappan et al 1 have fi red a salvo across this yawning chasm. This should spur more clinicians to analyse and interpret their data in the Indian context.…”

“…3 In the present study, a staggering 74% of cases were caused by bacteria and the overall outcome was very good, possibly refl ecting the early pick up and targeted treatment. 1 This is not often the case in most centres in India, where the diagnostic accuracy in central nervous system infections is abysmally low. Although it is tempting to extrapolate the results of this study to clinical practice, in reality, even with multiplex PCR panels, it is diffi cult to achieve diagnostic certainty in >30-40% of cases.…”

“…In this issue of the JRCPE, Petchiappan et al 1 present new data on community-acquired meningoencephalitis from a South Indian centre. In their prospective study they included 50 consecutive patients who had acute meningoencephalitis.…”

“…In the present study about 58% of cases were attributed to this organism. 1 Most cases were picked up by simple techniques, such as cerebrospinal fl uid analysis, and polymerase chain reaction (PCR) was used only in some instances.…”