Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Epidemiol Infect. 2024 Oct 10;152:e123. doi: 10.1017/S0950268824001225.
Subacute and chronic meningitis (SCM) presents significant diagnostic challenges, with numerous infectious and non-infectious inflammatory causes. This study examined patients aged 16 and older with SCM admitted to referral centers for neuroinfections and neuroinflammations in Mashhad, Iran, between March 2015 and October 2022. Among 183 episodes, tuberculous meningitis was the most common infectious cause (46.5%), followed by Brucella meningitis (24.6%). The cause of SCM was definitively proven in 40.4%, presumptive in 35.0%, and unknown in 24.6% of cases. In-hospital mortality was 14.4%, and 30.5% of survivors experienced unfavorable outcomes (Glasgow Outcome Scale 2-4). Patients with unknown causes had a significantly higher risk of death compared to those with presumptive or proven diagnoses (risk ratio 4.18). This study emphasizes the diagnostic difficulties of SCM, with one-quarter of cases remaining undiagnosed and over one-third having only a presumptive diagnosis. Improving diagnostic methods could potentially enhance prognosis and reduce mortality.
亚急性和慢性脑膜炎（SCM）具有显著的诊断挑战，有许多感染性和非感染性炎症原因。本研究调查了 2015 年 3 月至 2022 年 10 月期间在伊朗马什哈德的神经感染和神经炎症转诊中心住院的 16 岁及以上患有 SCM 的患者。在 183 例病例中，结核性脑膜炎是最常见的感染性病因（46.5%），其次是布鲁氏菌性脑膜炎（24.6%）。SCM 的病因明确的占 40.4%，推测性的占 35.0%，未知的占 24.6%。住院死亡率为 14.4%，30.5%的幸存者预后不良（格拉斯哥预后量表 2-4）。与推测性或明确诊断的患者相比，病因不明的患者死亡风险显著更高（风险比 4.18）。本研究强调了 SCM 的诊断困难，四分之一的病例仍未确诊，超过三分之一的病例仅进行了推测性诊断。改进诊断方法可能有助于改善预后并降低死亡率。
