KLEBSIELLA MENINGITIS IN TAIWAN - AN OVERVIEW

Klebsiella infection has been considered to be an uncommon cause of me ningitis. To determine its incidence and clinical features, we reviewe d the microbiologic records of cerebrospinal fluid (CSF) and blood cul tures and the medical records of patients with bacterial meningitis ad mitted between 1981 and 1995. Klebsiella meningitis was diagnosed in 7 9 patients with 83 episodes. All patients had klebsiella isolated from CSF and/or blood and typical symptoms and signs of acute bacterial me ningitis. Of these, 74 were over 16 years of age and 2 of the 5 childr en were infants. There was an increased prevalence rate of klebsiella meningitis after 1986. Of the 83 episodes, only 9 occurred between 198 1 and 1986, accounting for 7.8% of 115 cases with CSF and/or blood cul ture-proven acute bacterial meningitis, whereas in 1987-95, there were 74 episodes accounting for 17.7% of 419 bacteriologically proven case s. K. pneumoniae accounted for 69 episodes, K. oxytoca, 11 episodes an d K. ozaenae, 3 episodes. Male gender, diabetes mellitus and liver cir rhosis were commonly associated with K. pneumoniae meningitis. Neurosu rgical procedures were frequently associated with K. oxytoca meningiti s. All three patients with K. ozaenae meningitis had a primary disease of the nasopharyngeal pathway. The mortality rate due to K. pneumonia e was 48.5%, K. oxytoca, 10% and K. ozaenae, 0%. In patients with K. p neumoniae meningitis, poor prognostic factors included age over 60 yea rs, diabetes mellitus, bacteremia and severe neurological deficits on the first day of treatment.