Characteristics and outcome of spontaneous bacterial meningitis in patients with diabetes mellitus

Abstract

Background: Studies on bacterial meningitis in diabetics patients versus non-diabetics are scarce. In patients with diabetes, bacterial meningitis may have a different presentation, etiology and course. We analyzed and compared the characteristics and outcome of spontaneous BM in adult patients with and without diabetes mellitus (DM). Methods: We performed a single-center, prospective observational cohort study, conducted between 1982 and 2017, in a tertiary university hospital in Barcelona (Spain). The primary outcome measure was in-hospital mortality. Results: We evaluated 715 episodes of bacterial meningitis; 106 patients (15%) had diabetes mellitus. Patients with diabetes were older (median 67 [IQR 17] vs 49 [IQR 40] years, p < 0.001) and more often had a Charlson comorbidity score of ≥3 (40% vs 15%, p < 0.001). Neck stiffness (56% vs 75%, p < 0.001), headache (41% vs 78%) p < 0.001), nausea and/or vomiting (32% vs 56% p < 0.001), and rash (12% vs 26%, p = 0.007) were less frequent in diabetics, whereas altered mental status was more common. Streptococcus pneumoniae and Listeria meningitis were the most common etiologic agents (24 and 18%, respectively). Listeria was more frequent (18% vs. 10%, p = 0.033), whereas meningococcal meningitis was less frequent (10% vs 32%, p < 0.001). Overall mortality was higher in patients with diabetes (26% vs 16%, p = 0.025) concerning non-diabetics. Conclusions: Patients with bacterial meningitis and diabetes mellitus are older, have more comorbidities, and higher mortality. S. pneumoniae and L. monocytogenes are the predominant pathogens, Listeria being more common, whereas Neisseria meningitidis is significantly less frequent than in non-diabetics.

The Potentials of Melatonin in the Prevention and Treatment of Bacterial Meningitis Disease

“…[ 33 , 34 , 35 ]. Among elderly patients with bacterial meningitis, septicemia and respiratory failure were the primary cause of death; the main complication among younger patients was brain herniation [ 36 ]. If the host survives post-infection, it may leave pathogen-specific sequelae, such as deafness, blindness, or certain kinds of retardation.…”

An overview of the meningococcal disease and impact of the quadrivalent meningococcal conjugate vaccine

“…Most of the mortality cases occur in the bacterial meningitis (Griffiths et al, 2018), caused mainly by; Streptococcus pneumonia and N. meningitides. According to Pomar et al, (2020), approximately about 4-6 of infected cases per 100,000 adults are recorded annually in the industrialized countries. Older people are more vulnerable to infection by bacterial meningitis than younger ones (Domingo et al, 2013).…”

“…Thus, DM patients are more susceptible to developing bacterial meningitis compared to the non-diabetic patients. According to Pomar et al, (2020), the International Diabetes Federation (IDF) expected that by the year 2035; almost about 590 million individuals would have diabetes. Consequently, this disease will be a high-risk factor for meningitis (van Veen et al, 2016).…”

Association of Diabetes with Meningitis Infection Risks: A Systematic Review and Meta-Analysis

“…Due to further etiological complications of meningitis, even the association between diabetes and specifc subtypes of meningitis may not be consistent for the same population group. For instance, in a Spanish study, it was noted that diabetes mellitus was the strongest correlate of S. pneumoniae risk, followed by L. monocytogenes [31]. Conversely, age, pregnancy, an underlying cancer condition, and immunosuppression were signifcant predictors of L. monocytogenes instead of S. pneumoniae [31].…”

“…For instance, in a Spanish study, it was noted that diabetes mellitus was the strongest correlate of S. pneumoniae risk, followed by L. monocytogenes [31]. Conversely, age, pregnancy, an underlying cancer condition, and immunosuppression were signifcant predictors of L. monocytogenes instead of S. pneumoniae [31]. Since the advent of vaccines for managing meningitis, the etiological spectrums of the various pathogenic agents have changed signifcantly, thus making their association with underlying comorbidities or risk factors increasingly complex [31].…”