Clinical Course and Outcome of Community-Acquired Bacterial Meningitis in Cancer Patients.

Abstract

The aim of the study was to determine the course and outcome of bacterial meningitis (BM) in patients with cancer. We retrospectively reviewed files of patients with community-acquired BM, hospitalized in a single neuroinfection center between January 2010 and December 2017. There were 209 patients included in the analysis: 28 had cancer (9 women, 19 men; median age 76, IQR 67-80years) and 181 were cancer-free (76 women, 105 men; median age 52, IQR 33-65years) and constituted the control group. Cancer patients, compared with controls, were more likely to present with seizures (25% vs. 8%, p=0.019), scored higher on the Sequential Organ Failure Assessment, and had a higher mortality rate (32% vs. 13%, p=0.025). Further, cancer patients were less likely (64% vs. 83%, p=0.033) to present with two or more out of four clinical manifestations of BM (pyrexia, neck stiffness, altered mental status, and headache) and had a lower white blood cell (WBC) count than non-cancer controls. In multiple regression analysis, the presence of bacterial meningitis in cancer patients was independently associated only with older age (p=0.001) and lower WBC count (p=0.007), while mortality was associated with lower Glasgow Coma Score (p=0.003). In conclusion, bacterial meningitis in cancer patients is characterized by atypical symptoms and high mortality, which requires physicians' vigilance and a prompt investigation of cerebrospinal fluid in suspected cases. However, multiple regression analysis suggests that differences in clinical presentation and outcomes of bacterial meningitis between cancer and cancer-free patients may also be attributable to other factors, such as age differences.