Abstract • Review of records of patients aged 65 years and older admitted to The Mount Sinai Hospital, New York, NY, during the period from 1970 through 1985 revealed 57 episodes of central nervous system infections, including 50 meningitides, 5 brain abscesses, 1 subdural empyema, and 1 epidural abscess. Predisposing conditions were present in 17 patients with meningitis, and concurrent infections occurred in 19 patients. Streptococcus pneumoniae accounted for 43% of all isolates; 25% were gram-negative organisms. Of the patients in this sample, fever was present in 100%, meningismus was present in 58%, and change in mental status was present in 86%. Sixty-five percent of patients with meningitis survived; increased mortality was associated with altered mental status, inappropriate initial antibiotic therapy, and hypoglycorrhachia. Delay in diagnosis, underlying disease, and bacteremia did not significantly alter outcome. All patients with focal infections presented with localizing signs and all survived. (Arch Intern Med. 1989;149:1596-1599) References 1. Newton JE, Wilczynski PJG. Meningitis in the elderly . Lancet . 1979;2:157-158.Crossref 2. Berk SL. Bacterial meningitis . In: Gleckman RA, Gantz NM, eds. Infections in the Elderly . Boston, Mass: Little Brown & Co Inc; 1983:235-263. 3. Schwartz MN, Dodge PR. Bacterial meningitis—a review of selected aspects . N Engl J Med . 1965;272:725-731.Crossref 4. Fraser DW, Henke CE, Feldman RA. Changing patterns of bacterial meningitis in Olmsted County, Minnesota, 1935-70 . J Infect Dis . 1973;128:300-307.Crossref 5. Finland M, Barnes MW. Acute bacterial meningitis at Boston City Hospital during 12 selected years, 1935-72 . J Infect Dis . 1977;1366:400-415.Crossref 6. Quaade R. Meningitis in the aged . Geriatrics . 1963;18:860-864. 7. McGee ZA, Kaiser AB. Acute meningitis . In: Mandell BL, Douglas RG, Bennett JE, eds. Principles and Practice of Infectious Diseases . 2nd ed. New York, NY: John Wiley & Sons Inc; 1985:560-572. 8. Gorse GJ, Thrupp LD, Nudleman KL, Wyle FA, Hawkins B, Cesario TC. Bacterial meningitis in the elderly . Arch Intern Med . 1984;144:1603-1607.Crossref 9. Weiss W, Figueroa W, Shapiro WH, et al. Prognostic factors in pneumococcal meningitis . Arch Intern Med . 1967;120:517-524.Crossref 10. Quaade P, Kristensen KP. Purulent meningitis . Acta Med Scand . 1962;171:543-550.Crossref 11. Schwartz MN, Dodge RP. Bacterial meningitis—a review of selected aspects . N Engl J Med . 1965;272:779-787.Crossref 12. Wilson FM, Lerner AM. Etiology and mortality of purulent meningitis at the Detroit Receiving Hospital . N Engl J Med . 1964;271:1235-1238.Crossref 13. Hodges GR, Perkins RL. Acute bacterial meningitis—an analysis of factors influencing prognosis . Am J Med Sci . 1975;270:427-440.Crossref 14. Carpenter RR, Petersdorf RG. The clinical spectrum of bacterial meningitis . Am J Med . 1962;33:262-275.Crossref 15. Berk SL, McCabe WR. Meningitis caused by gram-negative bacilli . Ann Intern Med . 1980;93:253-260.Crossref 16. Jonsson M, Alvin A. A 12-year review of acute bacterial meningitis in Stockholm . Scand J Infect Dis . 1971;3:141-150. 17. Cherubin CE, Marr JS, Sierra MF, Becker S. Listeria and gram-negative bacillary meningitis in New York City, 1972-1979 . Am J Med . 1981;171:199-209.Crossref 18. Nieman RE, Lorber B. Listeriosis in adults: a changing pattern: report of eight cases and review of the literature, 1968-1978 . Rev Infect Dis . 1980;2:207-227.Crossref 19. Chou CH, Johnson JD, Hofstetter M, et al. Brain abscess . Medicine . 1986;65:415-431.Crossref 20. Scheld WM, Winn HR: Brain abscess . In: Mandell BL, Douglas RG, Bennett JE, eds. Principles and Practice of Infectious Diseases . 2nd ed. New York, NY: John Wiley & Sons Inc; 1985:585-591.
Archives of Internal Medicine – American Medical Association
Published: Jul 1, 1989
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