gms | German Medical Science

Objective: Meningitis is a rare but severe complication of patients with infectious spondylodiscitis. The incidence of this possibly fatal disease remains unclear due to a lack of studies reporting incidence and outcome of these patients. Aim of this retrospective monocentric study was to evaluate the incidence, clinical course and outcome.

Methods: A retrospective analysis of our clinical database was performed. Between January 2010 and June 2016 of 282 patients admitted to our department for spondylodiscitis, 14 patients (8 male, 6 female) (4.9%) suffered from an associated meningitis. Mean age at presentation was 70.5±10.75 yrs (range 48-88 yrs). We assessed clinical findings, laboratory tests, treatment and outcome.

Results: Diagnosis of meningitis was confirmed by CSF examination. Mean CSF cell count gained by lumbar puncture (n=10), external ventricular drainage (n=2) or lumbar drain (n=2) was 9899.23/µl ± 17524.78/µl (range 303-51528/µl). Mean time to diagnosis was 8.5 ± 8.2 days (range 1-27) after admission to our department. CSF examination was performed because of mental status change, coma or meningism. At time of hospital admission ten patients presented with neurological deficits (paraparesis n=6; tetraparesis n=4). Two patients required ICU treatment with ventilation at that time. Mean hospital stay was 37.4 ± 21.2 days (range 10-89). Eight patients required ICU treatment for an average of 19.7± 16.8 days. Tracheotomy was necessary in two cases. Successful isolation of the microbial or fungal organisms was possible in 13 cases. We found staphyloccocus aureus in seven patients, enteroccus faecium, streptococcusgroup B, candida albicans, klebsiella pneumoniae, clostridium perfringens or mycobacterium tuberculosis in one case each. Two patients developed hydrocephalus, one patient experienced cerebral infarction and epileptic seizures either because of meningitis or septic embolism. One patient died due to multiorgan failure, a 85 year old women was transferred to the palliative care unit after she became comatose and showed no improvement of her neurological status after a few weeks of treatment. At the time of transfer to the rehabilitation centre nine patients were still impaired by neurological deficits.

Conclusion: Bacterial meningitis due to bacterial or fungal spine infections is a rare but severe condition carrying a high morbidity and mortality. In patients with spine infection who present with somnolence and confusion an associated meningitis should be ruled out as soon as possible by CSF examination.