Acute bacterial meningitis in patients with nasopharyngeal carcinoma

Abstract

Introduction: Nasopharyngeal carcinoma (NPC) has a high prevalence in South-East Asia. It has been reported that acute bacterial meningitis (ABM) in patients with NPC had a higher mortality rate than patients without NPC.1,2 We aimed to study the clinical, radiological and cerebrospinal fluid (CSF) characteristics of ABM in patients with and without NPC. Methods: Retrospective review of medical records of ABM patients admitted to neurology ward, Queen Mary Hospital, from January 1997 to June 2008 was conducted. Clinical, radiological and CSF characteristics were studied. Results: A total of 26 ABM patients were managed during the study period. Mean age of the patients was 52.2 years, with male-to-female ratio 1.2:1. Positive CSF culture was present in 42% of patients. Five of the 26 had a history of NPC treated with irradiation prior to development of ABM. The mean interval between diagnosis of NPC to onset of ABM symptoms was 8 years (range, 1-23 years). There was no significant difference in presenting neurological features including mean Glasgow Coma Scale (15 in NPC group vs 13.8 in non-NPC group) between patients with and without NPC. Although there was difference in time interval between hospital admission and initiation of meningitic antibiotics therapy (60.2 hours in NPC group vs 12.9 hours in non-NPC group), there was no difference in duration of hospitalisation (21.8 days in both groups) or clinical outcome upon discharge measured by mean modified Barthel Index (80 in NPC group vs 85.8 in non-NPC group) and mortality rate (20% in NPC group vs 9.5% in non-NPC group). Conclusion: ABM in patients with NPC treated by irradiation does not have worse neurological prognosis than ABM in patients without NPC. References 1. Tang LM, Chen ST, Ng SH. Bacterial meningitis in patients with nasopharyngeal carcinoma. QJM 1996;89:71-6. 2. Huang CR, Lu CH, Chien CC, Lee PY, Chang WN. High incidence of gram-negative bacillary infection and high mortality in adult patients with bacterial meningitis and nasopharyngeal carcinoma. Eur J Clin Microbiol Infect Dis 2003;22:509-11.