FAVORABLE PROGNOSIS OF PURULENT-MENINGITIS IN PATIENTS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS

We prospectively reviewed all cases of purulent meningitis among human immunodeficiency virus (HIV) type 1-infected patients >14 years old t hat occurred at the Hospital General Vall d'Hebron (Barcelona) during the period 1 January 1985 through 31 March 1997. There were 12 episode s of purulent meningitis in nine of 2,150 HIV-1-infected patients. The annual rate of purulent meningitis was 0.465 cases per 1,000 patients , a rate that is 150 times higher than that for the general population . During 10 episodes, CD4(+) lymphocyte counts were <200/mm(3). The et iologic organism was Streptococcus pneumoniae in nine episodes (seven episodes occurred in four splenectomized patients), and Escherichia co li, Streptococcus agalactiae, and Enterococcus faecium each caused one episode. Clinical features and cerebrospinal fluid abnormalities were similar to those observed among patients without HIV-1 infection. All patients had bacteremia. The overall mortality was 8.3%. We conclude that purulent meningitis, particularly pneumococcal meningitis, is mor e frequent among HIV-1-infected patients than in the general populatio n. The prognosis for HIV-1-infected patients is better than for HIV-1- negative patients.