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Bacterial and fungal meningitis in patients with cancer

From the Department of Neurology and Neuroscience (J.E.S.), Weill Medical College of Cornell University, New York; Department of Medicine (P.A.M.), New York Presbyterian Hospital, Weill Cornell Campus; and Departments of Medicine (K.A.S.), Microbiology (T.E.K.), and Neurology (L.E.A.), Memorial Sloan-Kettering Cancer Center, New York, NY.

Address correspondence and reprint requests to Dr. Joseph E. Safdieh, 520 East 70th Street, Starr 607, New York, NY 10021 jos9046{at}med.cornell.edu

Objective: To analyze cases of bacterial and fungal meningitis in patients with cancer.

Methods: Retrospective chart review from 1993 to 2004 was performed of patients with cancer at our institution who had positive CSF bacterial or fungal culture.

Results: We identified 312 positive CSF cultures representing 175 unique presentations. Ninety-six cultures were deemed contaminants, leaving 79 cultures for analysis in 77 patients; 78% had prior neurosurgery. Organisms included 68% Gram-positive cocci, 10% Gram-positive bacilli, 14% Gram-negative bacilli, 7% Cryptococcus, and 1% C albicans. None had N meningitidis or H influenza. Two patients each had S pneumoniae or L monocytogenes. Five percent of presentations demonstrated the triad of fever, nuchal rigidity, and mental status changes. Seventy-five percent of presentations demonstrated CSF pleocytosis (10). Median CSF WBC count was 74 cells/mm³. CSF protein was elevated and glucose was depressed in 71%. In neutropenic patients (n = 6), 4 had 0 to 1 CSF WBC/mm³, and 2 had normal CSF. VP shunt infections were more likely to present with mental status changes. Thirty day mortality was 13%.

Conclusions: Patients with cancer do not manifest symptoms of meningitis as often as patients without cancer and display a very different set of CSF organisms compared to a general population. The CSF inflammatory response is muted in patients with cancer with meningitis. Most patients with cancer with meningitis have had prior neurosurgery. Additionally, the organisms causing meningitis in the cancer population have shifted over time, with a decline in the organisms which typically infect immunocompromised hosts and an increase in Gram-positive infections.

Abbreviations: CoNS = coagulase-negative Staphylococcus; MSKCC = Memorial Sloan-Kettering Cancer Center; PMN = polymorphonuclear leukocytes; VPS = ventriculoperitoneal shunts.

Supplemental data at www.neurology.org

Disclosure: The authors report no conflicts of interest.

Received September 20, 2007. Accepted in final form October 31, 2007.

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