-

275

.. 2541-2546
, .. , ..

Bacterial Meningitis in Buddhachinaraj Hospital during 1998-2003

Paworamon Sribussara, M.D. Siwarith Rusmeechan, M.D.

Abstract 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.
Keywords: bacterial meningitis, CNS infection, cerebrospinal fluid

276

Buddhachinaraj Medical Journal Vol 24 No. 3 September - December 2007

/:

:
:
:
.. 2541 .. 2546

: 316 198
118 1 -103 Streptococcal group (Strep group A, B, D
S. pneumoniae) [70 ( 52)] gram negative (E. coli, K. pneumoniae, Acinetobacter,
Proteus H. influenzae) 26 ( 19) S. pneumoniae 18 ( 13)
97 82

40 / 3 1-5 /
.. 40 /
16
:

: , ,

1


5-10 / 100,000 /
50 /
100,000 /2

1,3-4

Streptococcus pneumoniae 37-52,
Nisseria menigitidis 13-56, Listeria

monocytogenes 8-12.5, Haemophilus

influenzae 5 2,4-8
Streptococcus pneumoniae, Haemophilus
influenzae, Nisseria menigitidis3,9
Streptococcus suis,
group A streptococcus10-12

25
37 2,5-6,13

20-50
100-500 /
40 /
100-1,000 /

60

1,14-16

Streptococcus pneumoniae
0-30.2, Nisseria menigitidis 0-4.7
Haemophilus influenzae 0-37.2

277

12-64 17-19

(inclusion criteria)


.. 2541
.. 2546 (5 )
(exclusion criteria)


(
)
24

(stiffneck)

Buddhachinaraj Medical Journal Vol 24 No. 3 September - December 2007

278

(purulent meningitis, bacterial meningitis)



Glasgow coma score
15

Glasgow coma score
15

.. 2541
.. 2546
351
316
198 ( 63) 118
( 37)
(232 : 73)
1 103 (222 :
70) 15
16 60
80 80

( 28 29
) 1
1
(.. 41- .. 46)

()

88 (65)

47 (35)

135 (100)
104 (77)
31 (23)
( 1
( 1
-103 )
-103 )
1 -<1
21 (16)
1 -<15
15 (11)
>15 -60
69 (51)
>60 -<80
26 (20)
>80
3 (2)

1 -<1
3 (14)
1 -<15
1 (7)
>15 -60
9 (13)
>60 -<80
5 (19)
>80
1 (33)

19 (14)

198 (63)
118 (37)
316 (100)
232 (73)
84 (27)
( 1
-103 )
63 (20)
31 (10)
154 (49)
61 (20)
7 (2)
8 (13)
1 (3)
23 (15)
17 (28)
2 (29)
51 (16)

48
25 2

279

2
(.. 41-..46)
()

,
,

,

Sinusitis, osteomyelitis,
otitis media
ITP,
Pulmonary TB
Nephrotic syndrome

Gout
SLE

<15 >15 Streptococcal gram negative S. pneumoniae Staphylococcal H. influenza

0 (0)
3 (3)
0 (0)
1 (1)
0 (0)
0( 0)
7 (7)
0 (0)
0 (0)

48 (22)
22 (10)
15 (7)
12 (5)
12 (5)
9 (4)
0 (0)
4 (2)
3 (1)

17 (22)
0 (0)
3 (4)
5 (6)
0 (0)
0 (0)
1 (1)
0 (0)
0 (0)

3 (12)
2 (8)
2 (8)
1 (4)
3 (12)
5 (19)
0 (0)
2 (8)
0 (0)

3 (17)
3 (17)
0 (0)
0 (0)
0 (0)
0 (0)
1 (6)
0 (0)
0 (0)

1 (7)
3 (21)
0 (0)
1 (7)
0 (0)
1 (7)
1 (7)
1 (7)
0 (0)

0 (0) 48 (15)
0 (0) 25 (8)
0 (0) 15 (5)
0 (0) 13 (4)
0 (0) 12 (4)
0 (0) 9 (3)
0 (0) 7 (2)
0 (0) 4 (1)
0 (0) 3 (1)

2 (2)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
1 (1)
14 (15)

1 (0)
3 (1)
1 (0)
1 (0)
1 (0)
2 (1)
2 (1)
2 (1)
138 (62)

0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
2 (3)
28 (36)

1 (4)
0 (0)
1 (4)
1 (4)
0 (0)
1 (4)
1 (4)
0 (0)
23 (10)

2 (11)
2 (11)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
11 (5)

0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)

0 (0) 3 (1)
0 (0) 3 (1)
0 (0) 1 (0)
0 (0) 1 (0)
0 (0) 1 (0)
0 (0) 2 (1)
0 (0) 2 (1)
0 (0) 3 (1)
8 (57) 152 (48)

7
52
1-3
( 96) (
15 15
)
77 24
80
72 20
54 (
3)

()
<15 >15

1-3
4-7
7-14
>14

45 (48) 119 (54) 164 (52)

22 (23) 41 (18) 63 (20)
18 (19) 31 (14) 49 (16)
3 (3)
12 (5) 15 (5)
6 (6)
19 (9) 28 (8)
NA
NA

213 (96) 213 (96)

9 (4)
9 (4)

68 (72) 174 (78) 242 (77)

26 (28) 48 (22) 74 (23)

Buddhachinaraj Medical Journal Vol 24 No. 3 September - December 2007

280

3
()

()

4

(.. 41- .. 46)

<15 >15

38 (40)

56 (60) 196 (88) 252 (80)

. 0-24 .* 20 (21)

Stiffneck Positive
Negative

26 (12) 64 (20)

43 (19) 63 (20)

74 (79) 179 (81) 253 (80)

56 (60)

88 (40) 144 (46)

38 (40) 134 (60) 172 (54)

47 (50) 181 (82) 228 (72)
47 (50)

41 (18) 88 (28)

* >37.8 .
NA:

15 Streptococcal group
(Strep group A, B, D, S. pneumoniae)
(70 : 52) gram
negative (E. coli, K. pneumoniae, Acinetobacter,
Proteus, H. influenzae) S.
pneumoniae 15
S. pneumoniae, Staphy
locooccal (S. epidermidis, S. aureus) H.
influenzae 4
97
( 72) 82 ( 61)
( 44
)

<15 <15

() () () ()

Streptococcal group
(Strep group A, B, D) 4 (11) 66 (67) 70 (52) 4 (6)
Gram negative
(E.coli, K. pneumoniae,
Acinetobacter, Proteus) 5 (14) 21 (21) 26 (19) 8 (31)
S. pneumoniae
10 (28) 8 (8) 18 (13) 6 (33)
Staphylocooccal
(S. epidermidis, S. aureus) 10 (28) 4 (4) 14 (10) 1 (7)
H. influenzae
7 (19) 0 (0)
7 (5) 0 (0)

36 (100) 99 (100) 135 (100) 19 (14)

S. pneumoniae
6 18 ( 33)
gram negative ( H. influenzae) 8
26 ( 31) H.
influenzae (
4) 15
4 S. pneumoniae 3 S.
aureus 1
63

60 4 35
(8-18 )
3 (0-7
) (
15 15
) 5

( 5 /
.. )
5
( 2) 1-5 /..
2 ( 1) 1
1 ( 75)

50
25 ( 5)

281

( 59) 40 / (
40 / )
10 /
32 ( 41)
40 /
(
<45 / ) ( 5)
(CBC)
10,000 / ..
( 78) ( 5)

5 (..41-..46)
()

<15

>15

(.) ( 6-60)
0-7
8-18.
19-59
> 60

0 (0)
0 (0)
0 (0)
0 (0)

6 (3)
77 (35)
131 (59)
8 (4)

0 (0)
0 (0)
0 (0)
0 (0)

6 (3)
77 (35)
131 (59)
8 (4)

(/..) ( 0-29,200)
0
1-5
6-100
101-500
501-1,000
1,001-5,000
5,001-10,000
> 10,001

2 (2)
1 (1)
28 (30)
26 (28)
11 (12)
21 (22)
1 (1)
4 (4)

3 (1)
1 (0)
36 (16)
44 (20)
39 (18)
79 (36)
11 (5)
9 (4)

2 ( 1)
2 (1)
24 (18)
27 (20)
23 (17)
46 (34)
3 (2)
8 (6)

5 (2)
2 (1)
64 (20)
70 (22)
50 (16)
100 (32)
12 (4)
13 (4)

( 0-100)
0-25
26-50
51-75
76-100

22 (23)
11 (12)
12 (13)
49 (52)

26 (12)
20 (9)
44 (20)
132 (59)

20 (15)
10 (7)
30 (22)
75 (56)

48 (15)
31 (10)
56 (18)
181 (57)

Buddhachinaraj Medical Journal Vol 24 No. 3 September - December 2007

282

5 (..41-..46)

<15

()
>15

(/..) ( 0-158)
0-10
..-20
21-30
31-40
41-50
> 51

24 (26)
8 (9)
11 (12)
3 (3)
12 (13)
36 (38)

78 (35)
27 (12)
15 (7)
21 (19)
18 (8)
63 (28)

64 (47)
13 (10)
12 (9)
11 (8)
10 (7)
25 (19)

102 (32)
35 (11)
26 (8)
24 (8)
30 (10)
99 (31)

(/.) ( 13-4,500)
0-14
15-45
46-100
101-500
501-1,000
>1,000

3 (3)
7 (7)
18 (19)
54 (57)
4 (4)
8 (9)

6 (3)
19 (9)
19 (9)
66 (33)
85 (38)
27 (12)

2 (1)
6 (4)
4 (3)
92 (68)
24 (18)
7 (5)

9 (3)
26 (8)
37 (12)
120 (38)
89 (28)
35 (11)

48 (22)
174 (78)

25 (19)
110 (81)

70 (22)
246 (78)

(/..) ( 6,300-32,000)
<10,000
22 (23)
>10001
72 (77)

135
316
181
( 57)

60

5- 401

751

Streptococcus
pneumoniae, Nisseria menigitidis, Haemophilus
influenzae




1,14
3
Streptococcus pneumoniae gram
negative,
25 Streptococcus
pneumoniae, gram negative, Streptococcal group
8 17

24
80
92
24

72
(altered mental status)
58

72
15

3
(classic triad)

44 ( 95) 2
4
2,3,14

18

20 6
6-7 ( 8
)

283

(neonate)
20-21





15

5
4-10 22-24
15
1
17

(subarachnoid space) 22-24

1 1
5
75

25

Listeria monocytogen
8,25

40 /

284

Buddhachinaraj Medical Journal Vol 24 No. 3 September - December 2007

22

1.9 /
2.29 /
2,000 /

1,180
15

26

2


27
2

28-30

(PCR)

1-2

Streptococcus pneumoniae, Nisseria menigitidis,

Listeria monocytogenes, Haemophilus
influenzae2-9 Streptococcal group (Strep group A, B, D) ( S.
pneumoniae) 52
181 ( 57)

Nisseria menigitidis, Listeria monocytogenes
Streptococcal group (Strep group A, B, D)
S. agala ctia
(Strep group B)
60
31-32
Streptococcal group S. viridans
0.3-533-34 S. suis10 Strep group A11-12

Streptococcus pneumoniae,
Haemophilus influenzae14,35-37

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