Bacterial Meningitis in Buddhachinaraj Hospital during 1998-2003

PROBLEM/BACKGROUND: Bacterial meningitis occurs throughout the world. The causative organisms vary with patients’ age. Study of epidemiology and clinical manifestations in Thai bacterial meningitis patients, which differ from foreign textbooks, will provide for an accurate diagnosis and effective treatment.OBJECTIVE: To study prevalence, predisposing factors, causative organisms, characteristics and clinical manifestations, cerebrospinal fluid findings and associated mortality rate related to bacterial meningitis.RESEARCH DESIGN: Retrospective descriptive study.SETTING: Department of Medicine, Buddhachinaraj Phitsanulok Hospital.MATERIALS and METHOD: Chart review of all bacterial meningitis patients was conducted from October 1998 to September 2003. The data was analyzed and presented in frequency and percentage.RESULTS: There were 316 patients in this study, 198 males and 118 females. Age ranged from 1 day to 103 years. The most common causative organism was Streptococcal group (Strep. group A, B, D, not included S. pneumoniae) in 70 patients (52%), while others were gram negative (E. coli, K. pneumoniae, Acinetobacter, Proteus, not included H. influenzae) in 26 patients (19%), and S. pneumoniae in 18 patients (13%). Organisms were positive from CSF culture in 97 patients and from hemoculture in 82 patients. Headache and fever were the most common symptoms. In majority of cases, CSF fluid revealed pleocytosis with predominant polymorphonuclear cells. Most of the patients had decreased CSF glucose levels below 40 mg/dL and elevated protein levels, but normal or marginally elevated CSF white blood cell counts occurred in 3% of patients. Some of patients had CSF glucose levels more than 40 mg/dL. The overall mortality rate was 16 %.CONCLUSIONS: The causative organisms of bacterial meningitis in this study were different from other reports. The classic symptoms and signs may not found in all patients. CSF fluid usually abnormal but normal CSF fluid examination may occur.