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Morbidity and mortality for bacterial and viral meningitis
Bacterial meningitis causes long-term sequelae and results in significant mortality beyond the neonatal period. Prolonged or difficult-to-control seizures are predictors of complications. Bacterial meningitis can be extremely serious. Morbidity, mortality, and prognosis depend on the pathogen, the patient's age and condition, and the severity of acute illness.[17] Cerebral infarction and edema are predictors of poor outcome, as are the signs of disseminated intravascular coagulopathy and endotoxic shock. The presence of low-level pleocytosis (< 20 cells) in patients with bacterial meningitis suggests a poorer outcome. Advanced bacterial meningitis can lead to brain damage, coma, and death. Long-term sequelae are seen in as many as 30% of survivors and vary with etiologic agent, patient age, presenting features, and hospital course. Patients usually have subtle CNS changes. Serious complications include the following:
Mortality rates for bacterial meningitis are highest in the first year of life, decrease in midlife, and increase again in old age. Bacterial meningitis is fatal in 1 in 10 cases, and 1 in 7 survivors is left with a severe handicap, such as deafness or brain injury. Meningitis caused by S pneumoniae, L monocytogenes, and gram-negative bacilli has a higher case-fatality rate compared with meningitis caused by other bacterial agents. The prognosis of meningitis caused by opportunistic pathogens depends on the underlying immune function of the host. Many patients who survive the disease require lifelong suppressive therapy (eg, long-term fluconazole for suppression in patients with HIV-associated cryptococcal meningitis). Despite effective antimicrobial and supportive therapy, mortality rates among neonates remain high, with significant long-term sequelae in survivors. In patients with deficient humoral immunity (eg, agammaglobulinemia), enterovirus meningitis may have a fatal outcome. Among bacterial pathogens, pneumococcal bacteria cause the highest rates of mortality (20-30% in adults, 10% in children) and morbidity (15%) in meningitis. Mortality is 50-90% and morbidity is even higher if severe neurologic impairment is evident at the time of presentation (or with extremely rapid onset of illness), even with immediate medical treatment. The reported mortality rates for specific bacterial organisms are as follows:
Patients with meningococcal meningitis have a better prognosis than do those with pneumococcal meningitis, with a mortality rate of 4-5%; however, patients with meningococcemia have a poor prognosis, with a mortality rate of 20-30%. The mortality rate for viral meningitis (without encephalitis) is less than 1%. In patients with deficient humoral immunity (eg, agammaglobulinemia), enterovirus meningitis may have a fatal outcome. Patients with viral meningitis usually have a good prognosis for recovery. The prognosis is worse for patients at the extremes of age (ie, < 2 y, >60 y) and those with significant comorbidities and underlying immunodeficiency. Дата добавления: 2015-09-18 | Просмотры: 655 | Нарушение авторских прав |