ACUTE MENINGOCOCCAL MENINGITIS - ANALYSIS OF FEATURES OF THE DISEASE ACCORDING TO THE AGE OF 255 PATIENTS

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.