Klebsiella meningitis in Taiwan: an overview
|L.-M. TANG a1, S.-T. CHEN a1, W.-C. HSU a1 and C.-M. CHEN a1|
a1 Department of Neurology, Chang Gung Memorial Hospital
College of Medicine and Technology, 199 Tung Hwa North Rd., Taipei,
Klebsiella infection has been considered to be an uncommon cause
of meningitis. To determine
its incidence and clinical features, we reviewed the microbiologic records
of cerebrospinal fluid
(CSF) and blood cultures and the medical records of patients with
admitted between 1981 and 1995. Klebsiella meningitis was diagnosed in
79 patients with 83
episodes. All patients had klebsiella isolated from CSF and/or
blood and typical symptoms
and signs of acute bacterial meningitis. Of these, 74 were over 16 years
age and 2 of the 5
children were infants. There was an increased prevalence rate of
klebsiella meningitis after
1986. Of the 83 episodes, only 9 occurred between 1981 and 1986, accounting
for 7·8% of 115
cases with CSF and/or blood culture-proven acute bacterial meningitis,
whereas in 1987–95,
there were 74 episodes accounting for 17·7% of 419
bacteriologically proven cases. K.
pneumoniae accounted for 69 episodes, K.
oxytoca, 11 episodes
ozaenae, 3 episodes.
Male gender, diabetes mellitus and liver cirrhosis were commonly associated
pneumoniae meningitis. Neurosurgical procedures were frequently
associated with K.
meningitis. All three patients with K.
ozaenae meningitis had
a primary disease of the
nasopharyngeal pathway. The mortality rate due to K.
was 48·5%, K.
10% and K.
ozaenae, 0%. In patients with K.
meningitis, poor prognostic factors
included age over 60 years, diabetes mellitus, bacteremia and severe
neurological deficits on the first day of treatment.
(Accepted April 10 1997)