Infectious meningitis and encephalitis in adults in Denmark: A prospective nationwide observational cohort study (DASGIB)

Jacob Bodilsen, Merete Storgaard, Lykke Larsen, Lothar Wiese, Jannik Helweg-Larsen, Anne-Mette Lebech, Christian Brandt, Christian Østergaard, Henrik Nielsen, DASGIB study group

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Abstract

Objectives: To monitor epidemiological trends of infectious meningitis (bacterial and viral) and encephalitis in Denmark. Methods: Nationwide prospective observational study of all cases of proven community-acquired infectious meningitis and encephalitis in adults treated in all infectious diseases departments in Denmark from 1 January 2015 to 30 June 2016. We included data on symptoms, aetiology, treatment and outcome assessed by the Glasgow Outcome Scale (GOS) 30 days after discharge. GOS 1–4 was categorized as unfavourable outcome. Results: During 18 months of observation, we identified 252 cases of viral meningitis (3.6/100 000/year), 214 cases of bacterial meningitis (3.1/100 000/year) and 96 cases of infectious encephalitis (1.4/100 000/year). In bacterial meningitis, Streptococcus pneumoniae was the most frequent infectious agent (n = 101) followed by Staphylococcus aureus (n = 24) and β-haemolytic streptococci (n = 14). Meningococcal meningitis was rare (n = 11). In encephalitis, herpes simplex virus type 1 was most common (n = 37) followed by varicella zoster virus (n = 20), whereas varicella zoster virus (n = 61) was most common in viral meningitis followed by enterovirus (n = 50) and herpes simplex virus type 2 (n = 46). Case fatality and unfavourable outcome occurred in 31/214 (15%) and 96/214 (45%) with bacterial meningitis and in 5/96 (5%) and 55/89 (62%) with encephalitis. For viral meningitis, unfavourable outcome occurred in 41/252 (17%). Conclusions: The epidemiology and clinical presentation of the examined central nervous system infections differed considerably and bacterial meningitis was more frequent than previously estimated. Overall prognosis remains poor for bacterial meningitis and encephalitis. Prospective nationwide clinical databases of central nervous system infections may be superior to epidemiological monitoring based on notifications or laboratory systems.

Original languageEnglish
JournalClinical Microbiology and Infection
Volume24
Issue number10
Pages (from-to)1102.e1–1102.e5
ISSN1198-743X
DOIs
Publication statusPublished - Oct 2018

Keywords

  • Journal Article
  • Viral meningitis
  • Encephalitis
  • Bacterial meningitis
  • Prognosis
  • Risk
  • Central nervous system infections
  • Epidemiology
  • Prospective Studies
  • Community-Acquired Infections/epidemiology
  • Humans
  • Middle Aged
  • Male
  • Meningitis, Bacterial/epidemiology
  • Encephalitis, Herpes Simplex/epidemiology
  • Denmark/epidemiology
  • Female
  • Aged
  • Meningitis, Viral/epidemiology

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