Clinical Question: What is the epidemiology of meningitis and encephalitis in adults in the United States?
Background: Previous epidemiologic studies have been smaller with less clinical information available and without steroid usage rates.
Study Design: A retrospective database review.
Setting: The Premier HealthCare Database, including hospitals of all types and sizes.
Dr. Alan Hall
Synopsis: Of patients aged 18 or older, 26,429 were included with a primary or secondary discharge diagnosis of meningitis or encephalitis from 2011-2014. Enterovirus was the most common infectious cause (51%), followed by unknown etiology (19%), bacterial (14%), herpetic (8%), fungal (3%), and arboviruses (1%). Of patients, 4.2% had HIV.
Steroids were given on the first day of antibiotics in 25.9%. The only statistical mortality benefit was found with steroid use in pneumococcal meningitis (6.7% vs. 12.5%; P = .0245), with a trend toward increased mortality for steroids in fungal meningitis.
Of patients, 87.2% were admitted through the ED, though 22.5% of lumbar punctures were done after admission and 77.4% were discharged home.
Bottom Line: Enterovirus was the most common cause of adult meningoencephalitis, and patients with pneumococcal meningitis who received steroids had decreased mortality.
Citation: Hasbun R, Ning R, Balada-Llasat JM, Chung J, Duff S, Bozzette S, et al. Meningitis and encephalitis in the United States from 2011-2014. Published online, Apr 17, 2017. Clin Infect Dis. 2017. doi: 10.1093/cid/cix319.
Dr. Hall is an assistant professor in the University of Kentucky division of hospital medicine and pediatrics.