No 38 - 2011
Purulent meningitis 2010
Purulent meningitis 2010
Pneumococcal meningitisA total of 86 cases were notified. Among these, 83 were detected by culture, two by PCR and one by microscopy. For 29 patients, information was available on underlying conditions or predispositions: five had cancer, four were immuno-compromised, four were alcohol abusers, four had recently undergone neuro-surgery, three were suspected of fistula or dural defect, two had recently undergone ENT surgery, one had a base fracture of the skull and six had other underlying diseases. In 21 cases, there were other possible infection foci: 16 with an otogenic focus and/or sinusitis or other infection of the upper respiratory system, five with pneumonia and one with a dental focus. Information on sequelae was provided in 75 cases: 29 suffered no sequelae, 19 died, ten suffered hearing loss, ten neurological sequelae and seven had other sequelae.
Other streptococciOther streptococci were detected in six cases. Group B streptococci (GBS) were detected in four cases: a 66-year-old who died; a premature child, for whom the route of infection was unknown; two infants born at term, including one with vertical transmission and one for whom the route of infection was unknown. The three children were all discharged without sequelae. One 73-year-old had group G streptococci with unknown focus. This patient suffered sequelae in the form of amnesia. A 44-year-old had S. I ntermedius with unknown focus and sequelae in the form of hydrocephalus.
Haemophilus influenzaeThere were five notified cases of non-capsular H. influenzae. Three were discharged without sequelae and in two cases, information on sequelae was missing.
Listeria monocytogenesFive cases of meningitis caused by listeria were notified: A previously healthy two-year-old child, a 16-year-old with previous pneumococcal meningitis with no information on further investigation available, a 63-year-old with Down’s syndrome and two immunosuppressed patients aged 75 and 77, one with polymyalgia and one who had recently ended chemotherapy treatment. All patients were discharged without sequelae.
Other aetiologyStaphylococcus aureus was detected in four adults, one after neurosurgical intervention, one with an abscess in the piriform muscle, one with abscesses in the lumbar spine and one with endocarditis. Escherichia coli was detected in a prematurely born infant and in an 84-year-old with chronic obstructive pulmonary disease and recurrent urinary tract infections. Capnocytophaga canimorsus was detected in two patients: both had dogs, but only in one case a bite was observed. Vibrio cholerae type non-O1 was detected in a 66-year-old who had bathed in seawater. No predisposing factors were described.
Unknown aetiologyIn 20 cases, patients were notified on clinical tests and/or cerebrospinal fluid cell counts consistent with purulent meningitis, but without detection of bacteria by microscopy and culture. In 17 cases information on sequelae was provided: 12 survived without sequelae. Two died, one suffered from sequelae in the form of dizziness, one had aphasia and postural instability and one had other neurological sequelae.
CommentaryThe number of cases of purulent meningitis was in line with that of preceding years. The incidence of pneumococcal meningitis based on spinal fluid culture has decreased after the conjugated pneumococcal vaccine was included in the childhood vaccination programme in 2007. The decrease is most pronounced in children from 5.7/105 in 2000-2007 to 2.9/105 in 2008-2010, EPI-NEWS 19/11.
(J.N. Rasmussen, P. Valentiner-Branth, Dept. of Epidemiology, L. Lambertsen, S. Hoffmann, Dept. of Microbiological Surveillance and Research)
21 September 2011