Meningitis in elderly patients

Abstract

Meningitis is uncommon in elderly patients in emergency department (ED). The characteristics of bacterial meningitis (BM) and nonbacterial meningitis (NBM) occurring in older patients are compared. A prospective multicenter study was conducted in the EDs of three teaching hospitals. Consecutive adult patients (n=159) with a confirmed meningitis [cerebrospinal fluid (CSF) leukocyte count greater than 5 mm] were included in this study. Eighteen consecutive patients (11%) aged more than or equal to 60 years (median age of 67 years) presenting with confirmed meningitis were included. In the older group, the prevalence of BM was higher than in the younger group (50% vs. 11%, P<0.05). At admission in the ED, older patients experienced less typical symptoms of meningitis than the younger. Conversely, elderly patients presented more frequent signs of encephalitis. In older adults, CSF white blood cells count, CSF protein, and CSF/blood glucose ratio were different between NBM and BM. The causative species of BM were Streptococcus species other than pneumoniae in two episodes, and Streptococcus pneumoniae in two patients; the causative species of NBM were enterovirus in one episode, herpes simplex virus 1 in four (compared with the younger group, P<0.05), and varicella zoster virus in one. The prevalence of BM was higher in the older group than in the younger. Older patients experienced less typical symptoms of meningitis and more frequently signs of encephalitis, with a high prevalence of herpes simplex virus 1 meningitis.

Community‐Acquired Meningitis in Older Adults: Clinical Features, Etiology, and Prognostic Factors

“…Older participants have more comorbidities and neurological abnormalities on examination but have fewer symptoms of headache, nausea, stiff neck, and photophobia (Table ). These results are consistent with the current literature on acute bacterial meningitis in older adults . Neurological compromise can interfere with an individual's ability to relay important historical details, such as having a headache or stiff neck.…”

“…This study is the largest to analyze clinical features of and prognostic factors for community‐acquired meningitis of bacterial and nonbacterial causes in older adults. Existing studies have focused exclusively on confirmed cases of bacterial meningitis or have had limited sample size . The study demonstrated that community‐acquired meningitis in older adults differs significantly from in younger adults with respect to clinical features, etiology, and outcomes.…”

“…These results are consistent with the current literature on acute bacterial meningitis in older adults. 2,9,10 Neurological compromise can interfere with an individual's ability to relay important historical details, Odds Ratios (95% Confidence Interval) P-Value such as having a headache or stiff neck. This suggests that neurologic abnormalities are not only responsible for fewer meningitis symptoms, but may, in part, explain the variability of disease presentation described in older adults.…”

“…C ommunity-acquired meningitis encompasses a broad range of infectious and noninfectious causes, but existing studies in older adults have predominately focused on bacterial meningitis. 1,2 In recent decades, the epidemiology of meningitis has changed with the introduction of vaccines against Haemophilus influenzae type b and Streptococcus pneumoniae, the development of new diagnostic tools, and the discovery of new infectious etiologies, such as the West Nile virus. [3][4][5] Changes in host factors also play an important role, as the population shifts toward a larger aging cohort and conditions emerge that compromise the immune system.…”

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 .…”