Bacterial and fungal meningitis in patients with cancer

Abstract

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.