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Læknablaðið - 15.08.1995, Síða 16

Læknablaðið - 15.08.1995, Síða 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/

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