A 12-Year Review of Acute Bacterial Meningitis in Stockholm

Abstract

The hospital charts of 476 patients of all ages with bacterial meningitis were reviewed. Three-fourths of the patients were less than 15 years old, one-third less than 1 year. Two periods, 1956–1962 and 1963–1967, were compared. Two-thirds of the patients had Haemophilus influenzae, meningococcal, or pneumococcal infections. The rest had infections with Escherichia coli or coliform bacteria, streptococci, Staphylococcus aureus, Listeria monocytogenes, Mycobacterium tuberculosis, or cryptococci. No pathogen was isolated from the cerebrospinal fluid (CSF) in 18.1% of the patients. Cultures were negative in 29.7% of patients treated with antibiotics prior to admission, or twice as often as in those not so treated. Blood cultures were positive in 59% of fatal cases, in 29% of survivors. The total fatality rate decreased from 23% in the first period to 13% in the second. A poor cellular response in the CSF and in the blood, especially found in infants and elderly patients, bacteraemia and pre-existing surgical or medical diseases were associated with a particularly poor prognosis. The highest fatality rate was found in the E. coli/coliform and L. monocytogenes groups, almost only among the newborns, but it has decreased markedly during the last years. The prognosis for survival was best in the meningococcal group. The total frequency of sequelae was 19.1% with varying frequencies in different age groups. The most common residues were damage to the eighth cranial nerve complex in the adult patients and hydrocephalus and mental defects in the children.