J. Andersen et al., ACUTE MENINGOCOCCAL MENINGITIS - ANALYSIS OF FEATURES OF THE DISEASE ACCORDING TO THE AGE OF 255 PATIENTS, The Journal of infection, 34(3), 1997, pp. 227-235
Clinical and laboratory features of acute meningococcal meningitis acc
ording to age were studied in 255 patients. Whereas males accounted fo
r three out of five patients aged 0-4 years, females accounted for thr
ee out of four patients older than 50 years of age. All patients had c
linical signs of nuchal rigidity and fever. Patients older than 30 yea
rs of age had less frequent petechiae (62%) than younger patients (81%
). Furthermore, elderly patients above 50 years of age were prone to a
n obtunded mental state and a prolonged disease course with fever. Wit
hout relation to age, 2/3 had purulent meningitis and 2/3 had marked p
eripheral leucocytosis (>15 x 10(9) cells/l); 90% of patients had at l
east one of these findings. The cellular inflammatory response in peri
pheral blood indicated a bacterial aetiology in >95% of the cases. Mor
e than 80% of children and adults had abnormal CSF biochemical finding
s, but the level of protein and the glucose ratio (CSF/serum) were pos
itively and negatively correlated to increasing age of the patient, re
spectively: thus, in children these biochemical markers may be unrelia
ble in the differentiation between a bacterial and non-bacterial aetio
logy. Thrombocytopenia (<100.000 x 10(9)/l) was not associated with ag
e, though the lowest platelet count was found in elderly patients. The
case fatality rate was 7.5%, but neither age, sex nor sign of septica
emia was associated with fatality. Thrombocytopenia, a lowered coagula
tion index (<0.5, factors II, VII, X), a moderate anaemia (haemoglobin
<11 g/dl), an obtunded mental state and a history of convulsions were
poor prognostic factors; only anaemia was independently correlated to
fatality so this should be considered as an important prognostic mark
er in the acute phase of meningococcal meningitis.