THERAPY AND OUTCOME OF PNEUMOCOCCAL MENIN GITIS IN ADULTS - A RECENT SERIES OF 70 EPISODES

BACKGROUND: Pneumococcal meningitis (PM) is an infection with high mor bidity and mortality. The aim of this study was to evaluate the most r elevant clinical, epidemiologic and evolutive characteristics of a rec ent series of adult patients with this disease. METHODS: Over a period of 10 years all the patients with PM diagnosed by isolation of this m icroorganism in the cerebrospinal fluid (CSF) were evaluated from a cl inical, therapeutic and evolutive points of view. The impact of the ne w therapies in the disease and the variables associated with mortality were analyzed. RESULTS: Seventy episodes of PM were diagnosed, 60% be ing found in patients over the age of 50 years. The male/female relati onship was 2/1. Fifty-three percent of the patients had other underlyi ng diseases. Acute otitis media (AOM) was the source in 34% of the cas es, in 11% the patients had a fistula of CSF and in 9% a pneumonia. At the time of diagnosis 74% of the patients had some degree of reductio n in the level of consciousness and in 40% of the episodes the presenc e of neurologic local manifestations were observed. A decrease in sens itivity to penicillin was observed in 33% of the microorganisms isolat ed. Third generation cephalosporins were used as initial treatment in 57 episodes and penicillin in other 11 episodes. Adjuvant treatment wi th dexamethasone, mannitol and/or diphenylhydantoine was administered in 54% of the patients. Overall mortality was 23%: the factors associa ted with an unfavourable evolution were the existence of underlying di sease, deep alteration in the level of consciousness at the time of di agnosis, the coexistence of pneumonia and the absence of adjuvant ther apy. CONCLUSIONS: Mortality in pneumococcal meningitis is high. The mo st relevant risk factor is the initial degree of consciousness. Adjuva nt therapies probably determine a reduction in the rate of mortality.