Table 1.
Clinical and laboratory characteristics of 323 adults with meningitis and a negative Gram stain of cerebrospinal fluid
| New Orleans cohort (N = 205) n (%) |
Houston cohort (N = 118) n (%) |
Both cohorts (N = 323) n (%) |
P value | |
|---|---|---|---|---|
| Sex | ||||
| Male | 111 (54·1) | 59 (50) | 170 (52·6) | 0·49 |
| Age, years | ||||
| Mean (range) | 39·4 ± 13·6 (17–96) | 42·9 ± 16·4 (17 -82) | 41 ± 14·8 (17–96) | 0·04 |
| Ethnicity | ||||
| White | 46 (22·4) | 39 (33) | 85 (26·3) | 0·05 |
| African American | 151 (73·6) | 28 (23·7) | 179 (55·4) | <0·01 |
| Hispanic and others* | 8 (3·9) | 51 (43·2) | 59 (18·2) | <0·01 |
| Insurance | ||||
| Medicare/Medicaid | 56 (27·3) | 30 (25·4) | 86 (26·6) | 0·79 |
| Private | 35 (17·1) | 63 (53·3) | 98 (30·3) | <0·01 |
| Uninsured | 106 (51·7) | 21 (17·8) | 127 (39·3) | <0·01 |
| Unknown | 8 (3·9) | 4 (3·4) | 12 (3·7) | 1·10 |
| Co-existing medical conditions | ||||
| Charlson comorbidity index score >1 | 70 (34·1) | 21 (17·8) | 91 (28·2) | <0·01 |
| HIV positive | 59 (28·7) | 13 (11) | 72 (22·3) | <0·01 |
| Intravenous drug use | 23 (11·2) | 1 (0·8) | 24 (7·4) | <0·01 |
| Immune status | ||||
| Normal host | 137 (66·8) | 98 (83) | 235 (72·7) | <0·01 |
| AIDS | 37 (18) | 6 (5·1) | 43 (13·3) | <0·01 |
| Chronic steroids† | 6 (2·9) | 4 (3·4) | 10 (3·1) | 1·10 |
| Transplant patient‡ | 3 (1·4) | 3 (2·5) | 6 (1·8) | 0·67 |
| Recent antibiotic use§ | ||||
| Any antibiotic | 37 (18) | 37 (31·3) | 74 (22·9) | <0·01 |
| Risk factors | ||||
| Recent mosquito bites§ | 44 (21·4) | 22 (18·6) | 66 (20·4) | 0·57 |
| Recent ill contact§ | 33 (16·1) | 16 (13·5) | 49 (15·2) | 0·63 |
| History of sinusitis | 22 (10·7) | 16 (13·5) | 38 (11·8) | 0·63 |
| TB exposures | 18 (8·8) | 8 (6·8) | 26 (8·6) | 0·67 |
| History of otitis | 7 (3·4) | 8 (6·7) | 15 (4·6) | 0·18 |
| History of travel | 33 (16) | 14 (11·8) | 47 (14·5) | 0·33 |
| History tick bites | 5 (2·4) | 1 (0·8) | 6 (1·8) | 0·43 |
| Season | ||||
| Summer (June–August) | 67 (32·7) | 28 (23·7) | 95 (29·4) | 0·1 |
| Spring (March–May) | 51 (24·9) | 20 (16·9) | 71 (22) | 0·12 |
| Fall (September–November) | 44 (21·5) | 35 (29·6) | 79 (24·4) | 0·11 |
| Winter (December–February) | 43 (20·9) | 35 (29·6) | 78 (24·1) | 0·08 |
| Presenting history | ||||
| Headache | 172 (83·9) | 93 (78·8) | 265 (82) | 0·29 |
| Fever | 147 (71·7) | 72 (61) | 219 (67·8) | 0·06 |
| Nausea | 114 (55·6) | 61 (51·7) | 175 (54·2) | 0·56 |
| Stiff neck | 113 (55·1) | 57 (48·3) | 170 (52·6) | 0·24 |
| Photophobia | 100 (48·7) | 42 (35·6) | 142 (44) | 0·02 |
| Malaise | 88 (42·9) | 40 (33·9) | 128 (39·6) | 0·12 |
| Respiratory symptoms | 54 (26·3) | 23 (19·5) | 77 (23·8) | 0·14 |
| Seizures <7 days | 15 (7·3) | 20 (16·9) | 35 (10·8) | <0·01 |
| Presenting signs | ||||
| Temperature >38·4 °C | 100 (48·8) | 72 (61) | 172 (53·2) | 0·04 |
| Decreased level of consciousness (GCS <15) | 42 (20·5) | 40 (33·9) | 82 (25·4) | 0·01 |
| Nuchal rigidity | 53 (25·9) | 24 (20·3) | 77 (23·8) | 0·28 |
| Focal neurological deficits¶ | 26 (12·7) | 21 (17·8) | 47 (14·5) | 0·25 |
| Vesicular or petechial rash | 12 (5·9) | 5 (4·2) | 17 (5·3) | 0·61 |
| Serum WBC count, cells/μl, median (range) | 8200 (2300–31110) | 9200 (2400–64500) | 8600 (2300–64500) | 0·14 |
| CSF WBC count, cells/μl, median (range) | 51 (6–53790) | 131 (7–20421) | 79 (6–20421) | 0·03 |
| CSF protein, mg/dl, median (range) | 62 (6–1438) | 78 (16–7300) | 65 (6–7300) | 0·08 |
| CSF glucose, mg/dl, median (range) | 54 (0–316) | 52 (0–193) | 54 (0–316) | 0·46 |
| CSF ALC, cells/μl, median (range) | 80 (0–100) | 81 (2–100) | 80 (0–100) | 0·78 |
| CSF ANC > 500 | 2 (1) | 11 (9·3) | 13 (4) | <0·01 |
| CSF WBC > 1000 | 23 (11·2) | 15 (12·7) | 38 (11·8) | 0·72 |
HIV, Human immunodeficiency virus; AIDS, acquired immune deficiency syndrome; TB, Mycobacterium tuberculosis;
GCS, Glasgow Coma Scale; CSF, cerebral spinal fluid; ALC, absolute lymphocyte count; ANC, absolute neutrophil count; WBC, white blood cell.
Values given are n (%) unless stated otherwise.
P value by Fisher's exact test or two-way ANOVA
Includes Asian, Native Indian and unknown/declined to answer.
More than 0·5 mg/kg of methyl-prednisone or equivalent in the last 14 days,
After a solid organ or haematopoietic transplant and currently taking immunosuppression on a chronic basis.
Within the last 7 days,
Focal neurological deficits includes aphasia, palsy.