Epidemiology

Pneumococcal meningitis increases long-term mortality

Last Updated: 2010-08-06 19:30:26 -0400 (Reuters Health)

By Rob Goodier

NEW YORK (Reuters Health) - Pneumococcal meningitis patients have higher long-term mortality rates compared to the general public, due largely to neoplasms and liver and nervous system diseases, a Danish study has found.

The result implies the need for tighter screening of these patients for after-effects, the researchers write in the August 1st issue of the American Journal of Epidemiology.

"Before discharging patients treated for pneumococcal meningitis we should remember to meticulously examine (them) for neurologic sequelae, and especially in the adult patients keep in mind predisposing conditions to the disease, like smoking and alcohol abuse, chronic illnesses and cancers," lead author Dr. Casper Roed of the Copenhagen University Hospital told Reuters Health by email.

Using national data from 1977 through 2006, Dr. Roed and colleagues identified 2,131 patients who survived at least a year after a diagnosis of pneumococcal meningitis. They stratified these patients into four age groups and compared them to a group of 8,524 age- and gender-matched controls.

The overall observation times were 24,563 person-years for the patients and 105,620 person-years for the controls.

Adjusted mortality rates ranged from roughly six-fold higher in patients compared to controls in the 0-to-20-years age group to roughly 1.5-fold higher in the 60-to-79-year-olds.

Deaths due to oropharynx neoplasms were more than three times higher and hematologic neoplasms (in particular, multiple myeloma and chronic lymphocytic leukemia) were more than five times higher in patients compared to controls.

The 10-year risk of death from multiple myeloma was 2.9% in patients older than 50 years, compared to 0.1% in the control group.

"Presumably these patients at the time of diagnosis of pneumococcal meningitis already house an unrecognized neoplasm making them prone to invasive bacterial infection," Dr. Roed said.

Liver disease resulted in death only in patients older than 30, at a rate more than four times higher than in controls. In both groups, alcohol accounted for most liver-related deaths.

Besides stricter screening, Dr. Roed calls for better vaccination programs to lower the long- (and short-) term risk of death in meningitis patients.

SOURCE: http://link.reuters.com/mun73n

Am J Epidemiol 2010.