No 38 - 2010

Purulent meningitis 2009

2009 saw a total of 176 notified cases of purulent meningitis. Figure 1 and Table 1 show the distribution by aetiology and age. Meningococcal meningitis was reported separately in EPI-NEWS 17/10.

Pneumococcal meningitis

A total of 81 cases were notified. Among five cases with negative cultures, pneumococci were detected by PCR in three, by 16S RNA analysis in one case, and in one case the mode of detection was not stated. For 18 patients, information on underlying conditions or dispositions were stated: six immunocompromised patients, four alcoholics, four patients with possible fistula or dural defects, one with ENT surgery and three with other underlying conditions. A total of 27 patients had other infection foci: two had cerebral abscesses, one had psoas abscess, six had pneumonia among whom one developed aortitis, and 18 had otitis media and/or sinusitis of whom one also had septic arthritis and one endocarditis. Information on sequelae was provided in 75 cases: 21 patients died, ten suffered a hearing loss, three had neurological sequelae, nine developed other sequelae and 32 survived without sequelae.

Other streptococci

Other streptococci than pneumococci were detected in seven cases. Group B streptococci (GBS) were detected in three children aged from one day to 11 weeks and in two adults. All survived, but one of the adults suffered a complicated treatment course due to spondylodiscitis and epidural abscess. A 93-year-old patient with group G streptococci died. One patient with S. suis suffered cognitive sequelae.

Haemophilus influenzae

Haemophilus influenzae type B (Hib) was detected in a ten-month-old child, who survived without sequelae. The child had received two doses of Hib vaccine. A single case of non-capsular H. influenzae in an infant was notified; neurological sequelae were suspected. Furthermore, two cases of unknown serotype were notified; both survived.

Listeria monocytogenes

Meningitis due to listeria was notified in 11 cases, including a child who survived without sequelae. Among the ten adults, five were immunosuppressed, two had other underlying conditions and in three cases no information was stated. Five survived without sequelae, one died, one immunosuppressed female suffered a miscarriage during the disease, one had persisting headache, and in two cases no information on sequelae was provided.

Other and unknown aetiology

Escherichia coli was detected in one child and Moraxella osloensis was found in one child, who was immunosuppressed. Pseudomonas aeruginosa meningitis was observed in a femoral amputee, the bacterium was found in the femoral stump. Meningitis with Capnocytophaga canimorsus occurred in one patient who had been licked by a dog in a skin area with sores. All of these four patients survived. In a total of 22 cases, patients were notified on the basis of clinical tests and/or cerebrospinal fluid cell counts consistent with purulent meningitis, but without detection of bacteria by microscopy and culture. In one case, information on sequelae was missing, 18 survived with no sequelae, two suffered sustained headache and one suffered memory loss.

Commentary

The number of cases of purulent meningitis was in line with previous years. However, this year relatively many listeria meningitis cases were notified, which is probably associated with a general increase in the occurrence of listeria infections, EPI-NEWS 3/10. The previously described increase in the number of notified cases of GBS meningitis, EPI-NEWS 45/08 and 38/09, did not continue throughout 2009, but the reference laboratory continued receiving a considerable number of GBS blood isolates from infants.

(G. St-Martin, P. Valentiner-Branth, Dept. of Epidemiology, L. Lambertsen, S. Hoffmann, Dept. of Microbiologocal Surveillance & Research)

Individually notifiable diseases and selected laboratory diagnosed infections  

22 September 2010