Community-Acquired Recurrent Bacterial Meningitis in Adults

BACKGROUND: Community-acquired recurrent bacterial meningitis in adults is a relatively rare disease. All previous data were derived from small retrospective case series. METHODS: We prospectively evaluated episodes of recurrent bacterial meningitis in a nationwide cohort study in The Netherlands. RESULTS: Thirty-four episodes of recurrent bacterial meningitis were identified among 31 patients; 3 patients experienced 2 episodes during the study period. The mean age was 43 years, and 25 (74%) of 34 episodes occurred in men. Predisposing conditions were involved in 26 (77%) of 34 episodes; the most common predisposing conditions were remote head injury (17 [53%] of 32 episodes) and cerebrospinal fluid (CSF) leakage (9 [32%] of 28 episodes). Lumbar puncture revealed an individual CSF indicator of bacterial meningitis for almost all episodes (88%). The outcome was death for 5 (15%) of 34 episodes; 1 additional patient had a suboptimal score on the Glasgow Outcome Scale. CONCLUSION: We conclude that most patients with recurrent meningitis are male and have predisposing conditions, which, in most cases, are remote head injury or CSF leakage.