Clinical Presentations and Factors Associated with in-Hospital Mortality of Patients Diagnosed with Subacute and Chronic Infectious Meningitis in A Mexican Hospital

Abstract

Subacute and chronic infectious meningitis are well defined clinical entities although scarcely reported in medical literature [1]. While chronic meningitis is defined as a leptomeningeal inflammation with persistent neurological symptoms with cerebrospinal fluid (CSF) changes which include protein increase, lymphocytic pleocytosis and low glucose lasting 4 weeks or more, [2,3]. subacute meningitis time span is not as well defined but includes those cases from five days to less than four weeks in duration not to mention shorter-lasting presentations with the aforementioned CSF changes [4,5]. Independent on their temporal evolution, both entities distinguish by having typical clinical manifestations, which include headache, nuchal rigidity, photophobia, and variable grades of cognitive impairment. Fever when present is usually lower than 39 o Celsius. Unlike acute meningitis, signs, and symptoms in subacute/ chronic meningitis follow a more indolent course. In any case during that course, severe consciousness state deterioration, seizures, encephalitis, granulomas and abscesses, hydrocephalus, and other forms of brain, spinal cord, peripheral or cranial nerves can occur [4,6]. Background: Subacute/chronic meningitis are well-characterized clinical entities whose differential diagnosis is broad and challenging to address, resulting in a third of cases without an etiological diagnosis. In the world literature and especially in our country few studies describe the clinical patterns of presentation of the most common forms of subacute/chronic infectious meningitis, as well as what is the relationship of these patterns to in-hospital mortality. Cases of chronic meningitis in our environment may be over diagnosed as tuberculous meningitis because of its high regional frequency. Thus, we seek to establish the frequency of diagnostic confirmation in our region as well as identify risk factors link to in-hospital mortality. Methods: We studied clinical records of patients with a diagnosis of chronic and subacute meningitis at discharge in five years. Clinical and auxiliary test data were analyzed to find their association with in-hospital mortality. Results: We found that the most frequent sign in this population was acute cognitive impairment (75.5%), followed by a headache. The majority of the cases was associated with meningeal tuberculosis. We found an association between immunosuppression, diminished level of arousal, prolonged time of disease progression, CSF acute inflammatory pattern, and hydrocephalus in the hospital mortality. Subacute and chronic meningitis are less frequent than their acute counterpart, and that is why we do not know their precise incidence rates [7]. In addition to this, there are other epidemiological aspects which hinder their study including the diverse etiological causes by geographical region [8,9]. Diagnosis for this type of meningitis is extensive and comprise many forms of infectious and non-infectious diseases (Table 1). The most frequent infectious chronic meningitis is caused by Myc...