MED-8. Clinical and epidemiological profiles of bacterial and fungal meningitis in two Baltimore hospitals.

We studied the clinical and epidemiologic profiles and prevalence of meningitis in two community hospitals to determine whether presentations were different. We also recorded inpatient HIV prevalence, and tried to determine whether bacterial meningitis (BM) could be distinguished from cryptococcal meningitis (CM) at the time of admission based on clinical findings and cerebrospinal fluid analysis. Franklin Square Hospital (located in a working class suburb) and Union Memorial Hospital (located in the inner city) are two community hospitals in Baltimore serving distinctly different populations. HIV prevalence at each institution was determined from DRG billing data. Positive CSF cultures, stains, and antigens were retrospectively identified through computerized microbiology logs in the time frame of January 1, 2001, through June 30, 2003. Inpatient charts were reviewed by a team of faculty, residents, and students. Demographic and clinical data on meningitis cases were collected and reviewed. Two-year HIV prevalence was 2.8% at Union Memorial and 0.6% at Franklin Square. Twenty-eight cases of meningitis were identified: 15 C neoformans, 8 S pneumoniae, 3 N meningitides, and 2 S aureus. Eleven cryptococcal cases were identified at UMH compared to 4 at FSH, despite the latter having 20% more total admissions. The mean CSF cryptococcal antigen titer was 1:256 (all CM cases that were tested were positive); the mean serum antigen 1:1026. In BM: mean CSF white count was 793; in CM 26 (P = 0.035). The mean BM neutrophil percent was 93; in CM 12 (P <0.001). In BM, the mean total protein was 595; in CM 96 (P <0.001). The most discriminating clinical findings were the presence of headache and insidious onset in CM and an abnormal CT and seizures in BM; 14% of CM patients died in the hospital; 32% of BM died. Cryptococcal meningitis was overall the most frequent cause of microbiologically proven meningitis in two Baltimore region community teaching hospitals, and was roughly proportional in prevalence to the HIV prevalence in each hospital. CSF antigen titers were very reliable in both bacterial and fungal meningitis. Clinical findings, particularly headaches, seizures, insidious onset and CT results are diagnostically helpful in distinguishing BM from CM. Higher CSF white count, neutrophil percent and protein levels strongly support bacterial vs. cryptococcal infection.

Sy Sarkar, MD, Tarik Haddad, MD, Shalinee Khurana, Jack McCue, MD, and Robert Ferguson, MD. Union Memorial Hospital, Baltimore, MD. Franklin Square Hospital, Baltimore, MD.