Clinical picture of meningitis in the adult patient and its relationship with age

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.

Healthcare‐Associated Meningitis or Ventriculitis in Older Adults

“…The diagnosis of bacterial meningitis in older adults has been thought to be challenging because of clinical variability, atypical presentation, and fewer symptoms than in younger adults, although a previous study reported a significantly higher prevalence of the triad of fever, neck stiffness, and altered mental status in older (58%) than in younger (36%) adults with bacterial meningitis. Our cohort also had a higher rate of altered mental status in older than younger adults, similar to previous community‐acquired or bacterial meningitis studies . No significant differences were found in fever or other neurological signs and symptoms between the groups.…”

Sepsis and Other Infectious Disease Emergencies in the Elderly

“…110–115 Predisposing conditions such as otitis, sinusitis, or pneumonia may be present and sepsis may complicate up to a third of cases. 112,114–116 Elders may have fever, headache, or neck stiffness, but more commonly exhibit altered mental status, seizure, stupor, or coma. 111–117 Abnormal neurological findings are often present, including focal motor deficits, cranial nerve abnormalities, and aphasia.…”

Prehospital Heart Rate and Blood Pressure Increase the Positive Predictive Value of the Glasgow Coma Scale for High-Mortality Traumatic Brain Injury

“…4 In addition, the GCS is often relied upon in prehospital research to help control for degree of TBI (for example, see Davis and colleagues 5 ), even though it was not originally intended, nor validated, for this clinical context. Indeed, the GCS is currently being used for non-TBI patients, for instance, to measure brain function in meningitis 6 and hypothyroidism 7 cases. Overall, the GCS has evolved to become a near-universal measure for global mental function, despite its original intent and validation in TBI patients subsequent to stabilization.…”