Clinical and prognostic approach towards pyogenic meningitis- a prospective study from kashmir india

Background:-Despite the availability of potent antibiotics the mortality rate of Pyogenic Meningitis (PM) remains significantly high in India. Clinical triad of head, fever and neck stiffness forms the core presentation of PM. However, the reports on sensitivity of this clinical triad among PM patients and association of various prognostic factors towards PM is not conclusive in the study population.
Aim:-The current study was aimed to assess the sensitivity of clinical triad and role of various prognostic markers among PM subjects.
Materials and Methods:-The study was conducted at Sher-i-Kashmir Institute of Medical Science, Srinagar from 2014-2016. All cases of acquired bacterial meningitis who fulfilled the inclusion criteria were included in the study. In total 70 cases were recruited in the current study. Outcome of cases was classified as unfavorable and favorable on the basis of Glasgow Scale. Glasgow outcome scale (GOS) of 1-4 was classified as unfavorable and Glasgow Coma scale (GCS) of >14 as favorable.
Results:-The majority of cases belonged to young and middle age groups (21-40 years) with 37±15.4 years as mean age of presentation. Headache 91.4 % and fever 87.1% were most common symptom. Sensitivity of the triad of fever, neck stiffness and altered mental status was 45.7%. Focal neurological deficit was found in 31.4% of cases while as cranial Nerve Palsy (CNP) was found in 19.8% of cases with cranial nerve 6 palsy being most prevalent. Altered mental status indicated by GCS<14 was found in 60.5% of cases.
Higher counts in blood culture and CSF gram staining was positive in 7.1% of cases. Total leukocyte, differential leukocyte counts and protein levels associated with unfavorable outcome in CSF were statistically significant (P< 0.05).
Conclusion:-Acute PM is disease of young adults. Cases with GCS >14 has 0% unfavorable outcome. CSF leucocyte count, Gram staining and culture has significant impact on the outcome of patient with PM.