Predisposing conditions and outcome in adult patients with recurrent pneumococcal meningitis

Introduction: Recurrent pneumococcal meningitis is a relatively rare condition associated with predisposing factors. The objective of the study was to evaluate the characteristics and predisposing factors for recurrent pneumococcal meningitis in adults and compare them to patients with non-recurrent meningitis. Methods: A retrospective record review was performed of all patients hospitalized for pneumococcal meningitis in a large tertiary referral center, during a 10-year period. Results: We identified a total of 194 pneumococcal meningitis episodes in 182 patients. Thirty-eight (20%) meningitis episodes in 26 patients were recurrent. Anatomical defects and/or CSF leakage were present in 55% of recurrent pneumococcal meningitis vs. 10% of non-recurrent episodes (p<0.001). Impaired immune response was encountered in 41% non-recurrent meningitis vs 24% of recurrent episodes (p=0.02). Median age in patients with recurrent meningitis was 29 years, while patients with non-recurrent meningitis had a median age of 57 years (p<0.001). The in-hospital mortality was 3% in patients with recurrent meningitis vs 27% in patients with non-recurrent meningitis (p<0.001). An unfavorable outcome was more likely to occur in patients with advanced age and an impaired immune status. Conclusions: Patients with recurrent pneumococcal meningitis were younger, had less comorbidities and a better outcome