Community-acquired purulent meningitis: a review of 1,316 cases during the antibiotic era, 1954-1976.

This review of 1,316 cases of purulent meningitis assessed changes in the etiology, clinical features, and fatality rate during the antibiotic era. Hemophilus influenzae was the most frequent cause of purulent meningitis (458 cases), Neisseria meningitidis the second most frequent (396 cases), and Streptococcus pneumoniae the third most frequent (178 cases). No bacterial etiology was found for 148 patients with purulent meningitis, the fourth major category of meningitis throughout the 23 years surveyed. Few patients had notable underlying diseases or predisposing conditions; 77.4% were less than 10 years old, but only 13 patients were less than one month old. Patients with meningitis caused by Staphylococcus aureus or various streptococci commonly had associated suppurative foci and the highest fatality rate. There were 103 deaths, of which 70.8% occurred during the first 48 hr of hospitalization. Antibiotics had been given to 54.6% of patients before admission to the hospital. Bacteriologic and cerebrospinal fluid (CSF) findings for patients who received antibiotics prior to admission ("pretreated") were compared with these findings for those who had not had antibiotics in 1,032 cases of meningitis caused by H. influenzae, N. meningitidis, or S. pneumoniae. No significant differences in white blood cell counts or in glucose or protein concentrations in CSF were noted among patients infected with any of the three organisms; positive cultures of blood and CSF were significantly less frequent in "pretreated" patients whose disease was caused by any of the three organisms, and particularly in those with meningitis due to N. meningitidis. Nasopharyngeal, throat, and rectal swabs and CSF specimens from 141 patients were cultured for virus. Enteroviruses were isolated from rectal swabs of two patients with bacterial meningitis and from the CSF of two patients (in mixed culture with Salmonella enteritidis in one case).