Læknablaðið - 15.08.1995, Page 16

594
LÆKNABLAÐIÐ 1995; 81
Heilahimnubólga af völdum baktería
hjá fullorðnum á íslandi
Yfirlit 20 ára
Bryndís Siguröardóttir11 , Ólafur Már Björnsson1’ , Kristín Jónsdóttir2’ , Helga Erlendsdóttir2’,
Siguröur Guömundsson1,3’
Sigurðardóttir B, Björnsson ÓM, Jónsdóttir K,
Erlendsdóttir H, Guðmundsson S
Acute bacterial meningitis in adults, a 20 year
overview
Læknablaðið 1995; 81: 594-604
Introduction: Although acute bacterial meningitis is
most common among children, the disease never-
theless poses serious problems in the adult pop-
ulation. However, most clinical overviews of the
disease have either focused on children or all age
groups combined.
Subjects and methods: Information on all patients
>16 years of age diagnosed in Iceland during the
years 1975-1994 was collected from patient records
from 10 hospitals and the records of the Dept. of
Microbiology at the University Hospital which proc-
esses all bacterial isolates from the CSF identified in
the country.
Results: One hundred thirty six patients were identi-
fied, but complete records were found for 123 pa-
tients. Yearly incidence ranged from 1.7-7.2/100,000
inhabitants with a mean of 3.8/100,000. The most
common causative organisms were Neisseria menin-
gitidis (54%), Streptococcus pneumoniae (20%),
Listeria monocytogenes (6%) and Haemophilus in-
fluenzae (5%). The relative incidence of N. meningi-
tidis was dependent on age, the organism caused
93% of infections in the 16-20 year age group,
whereas only 25% of infections in subjects >45
years of age were due to meningococci. On the other
hand, the relative incidence of S. pneumoniae did
increase from 2% in the younger age group to 37%
Verkefnið var unnið sem rannsóknarverkefni fjórða árs
laeknanema við læknadeild Háskóla Islands 1994.
Frá 1,læknadeild Háskóla Islands, 2)sýklafræðideild og 3,lyf-
lækningadeild Landspítalans. Fyrirspurnir, bréfaskipti: Sig-
urður Guðmundsson, lyflækningadeild Landspítalans, 101
Reykjavík.
in the older subjects. L. monocytogenes caused 14%
of cases among patients >45 years of age. The mean
mortality was 19.1% and did not change significantly
during the study period. A significant underlying
illness or condition was present in 39% of the pa-
tients. During the first third of the study period
penicillin or ampicillin alone or in combination with
chloramphenicol were used as initial empiric ther-
apy in 76% of cases, wheras during the last third of
the period these agents were used initially in 24% of
patients. The third generation cephalosporins either
alone or in combination were instead employed for
empiric treatment in almost two-thirds of the pa-
tients.
Conclusions: Meningococci were the most common
cause of bacterial meningitis in adults in Iceland
during the study period, albeit age dependent, and
causing only a fourth of infections in patients >45
years of age. Mortality did not change during the
period. The third generation cephalosporins are
now the most commonly used agents for empiric
therapy.
Ágrip
Inngangur: Þótt heilahimnubólga af völdum
baktería sé algengust hjá börnum er sjúkdóm-
urinn einnig alvarlegt vandamál hjá þeim sem
eldri eru. Lítið hefur hins vegar verið fjallað
um sjúkdóminn hjá unglingum og fullorðnum
sérstaklega.
Aðferðir: Upplýsingar um sjúkdómsferil
fólks 16 ára og eldri sem greindist með heila-
himnubólgu af völdum baktería eða meningó-
kokkablóðsýkingu á árunum 1975-1994 voru
fengnar úr sjúkraskrám 10 sjúkrahúsa í landinu
og skrám sýklafræðideildar Landspítalans.
Niðurstöður: Skrár sýklafræðideildar höfðu
að geyma upplýsingar um 136 tilfelli. Sjúkra-
skrár 123 þeirra fundust og byggjast niðurstöð-
ur um sjúkdómsferil á þeim að undanskildum
nýgengitölum, orsakavöldum og dánartíðni.
Nýgengi sjúkdómsins sveiflaðist milli 1,7 til 7,2/