BACTERIAL-MENINGITIS IN PATIENTS WITH NASOPHARYNGEAL CARCINOMA

Bacterial meningitis was found in 12 patients with nasopharyngeal carc inoma, accounting for 0.65% of the 1850 patients with the tumour diagn osed between 1981 and 1994 in our hospital. In 11 patients, the time-l ag between diagnosis of cancer and the appearance of infection ranged from 9 months to 11 years (mean 57 months) whereas in one patient it w as only 5 days. Three patients developed mixed bacterial meningitis. C erebrospinal fluid culture for bacteria was positive in six patients. Three patients (25%) were bacteraemic. Gram-negative bacilli, especial ly Pseudomonas aeroginosa, were the most common pathogens. Age, sex an d histopathology were not risk factors for infection. Conditions predi sposing to meningitis included intracranial invasion of the tumour, ne utropenia, otitis media, and neurosurgical procedures. All but two pat ients had intracranial tumour invasion and erosion of the base of the skull. Local spread of micro-organism to the meninges was more importa nt than haematogenous spread. The overall mortality in our patients wa s 66.7%, much higher than in patients without cancer.