Is Infectious Meningitis/Encephalitis a Notable Problem in Older Adults Admitted to Emergency Department with Altered Mental Status?

GÜRSOY, fahriye melis; AYDOS, ÖMER; AYAZ, CAGLAYAN MERVE; Ceylan, Serdar; GÜNER, RAHMET

doi:10.4274/ejgg.galenos.2022.2022-10-2

Is Infectious Meningitis/Encephalitis a Notable Problem in Older Adults Admitted to Emergency Department with Altered Mental Status?

Cağlayan AYAZ, (Ankara Şehir Hastanesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniği, Ankara, Türkiye)

Fahriye MELİS GÜRSOY, (Ankara Şehir Hastanesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniği, Ankara, Türkiye)

Ömer AYDOS, (Ankara Şehir Hastanesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniği, Ankara, Türkiye)

Serdar CEYLAN, (Hacettepe Üniversitesi, Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Geriatri Anabilim Dalı, Ankara, Türkiye)

Rahmet GÜNER (Ankara Yıldırım Beyazıt Üniversitesi, Ankara Şehir Hastanesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniği, Ankara, Türkiye)

European journal of geriatrics and gerontology (Online)

0 0

Yıl: 2023 Cilt: 5 Sayı: 1 Sayfa Aralığı: 36 - 45 Metin Dili: İngilizce DOI: 10.4274/ejgg.galenos.2022.2022-10-2 İndeks Tarihi: 30-05-2023

Is Infectious Meningitis/Encephalitis a Notable Problem in Older Adults Admitted to Emergency Department with Altered Mental Status?

Öz:

Objective: Altered mental status (AMS) is challenging diagnosis. It was aimed to evaluate the underlying causes, reveal laboratory, microbiological and imaging findings, and determine the infectious process in older patients who presented with AMS. Materials and Methods: This retrospective study was conducted at a training and research hospital. Sixty-five year and older patients who presented with AMS and underwent lumbar puncture, were included. Results: Among 98 older patients with AMS, the median age was 75.0 years (interquartile range: 69.0-75.0) and 58.2% of patients were female. Of the patients, 26.5% meningitis/encephalitis, 33.6% other infection sources, and 39.8% other disorders were found, respectively. Cerebrospinal fluid (CSF) white blood cell and protein levels were found higher; CSF chloride levels were detected lower in meningitis/encephalitis group. In brain, magnetic resonance imaging (p<0.001) and electroencephalogram (p=0.009) were found more pathologies suggesting infection in meningitis/ encephalitis patients, while brain computed tomography revealed no differences between meningitis/encephalitis and other diagnoses group. The need for intensive care was higher in the other disorder group (p=0.02) while admission to service was higher in the meningitis/encephalitis group (p=0.03). Conclusion: Clinical characteristics failed to differentiate between meningitis/encephalitis and other diagnoses in older patients with AMS, and CSF analysis, cranial imaging methods were required for the final diagnosis.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Gerson LW, Counsell SR, Fontanarosa PB, Smucker WD. Case finding for cognitive impairment in elderly emergency department patients. Ann Emerg Med 1994;23:813-817.
2. Lewis LM, Miller DK, Morley JE, Nork MJ, Lasater LC. Unrecognized delirium in ED geriatric patients. Am J Emerg Med 1995;13:142-145.
3. Hustey FM, Meldon SW. The prevalence and documentation of impaired mental status in elderly emergency department patients. Ann Emerg Med 2002;39:248-253.
4. Huff JS. Confusion. In: Marx J HR, Walls R. Editors. Rosen’s Emer- gency Medicine 7th Ed. Philadelphia: Mosby Elsevier; 2010: pp. 1056-1062.
5. Aslaner MA, Boz M, Çelik A, Ahmedali A, Eroğlu S, Metin Aksu N, Eroğlu SE. Etiologies and delirium rates of elderly ED patients with acutely altered mental status: a multicenter prospective study. Am J Emerg Med 2017;35:71-76.
6. van de Beek D, Cabellos C, Dzupova O, Esposito S, Klein M, Kloek AT, Leib SL, Mourvillier B, Ostergaard C, Pagliano P, Pfister HW, Read RC, Sipahi OR, Brouwer MC. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect 2016;22(Suppl 3):S37-62.
7. Tunkel AR, Glaser CA, Bloch KC, Sejvar JJ, Marra CM, Roos KL, Hartman BJ, Kaplan SL, Scheld WM, Whitley RJ. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2008;47:303-327.
8. van de Beek D, Brouwer M, Hasbun R, Koedel U, Whitney CG, Wijdicks E. Community-acquired bacterial meningitis. Nat Rev Dis Primers 2016;2:16074.
9. Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, Whitley RJ. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004;39:1267-1284.
10. Wang AY, Machicado JD, Khoury NT, Wootton SH, Salazar L, Hasbun R. Community-acquired meningitis in older adults: clinical features, etiology, and prognostic factors. J Am Geriatr Soc 2014;62:2064-2070.
11. Domingo P, Pomar V, de Benito N, Coll P. The spectrum of acute bacterial meningitis in elderly patients. BMC Infect Dis 2013;13:108.
12. Stone MJ, Hawkins CP. A medical overview of encephalitis. Neuropsychol Rehabil 2007;17:429-449.
13. Singh TD, Fugate JE, Rabinstein AA. The spectrum of acute encephalitis: causes, management, and predictors of outcome. Neurology 2015;84:359-366.
14. Fitch MT, Abrahamian FM, Moran GJ, Talan DA. Emergency department management of meningitis and encephalitis. Infect Dis Clin North Am 2008;22:33-52, v-vi.
15. Tintinalli JE, Cline DM, Stapczynski JS, Yealy D, Meckler GD, Ma OJ, Thomas SH. Tintinalli’s emergency medicine: a comprehensive study guide. E-book.
16. Hansen MA, Samannodi MS, Castelblanco RL, Hasbun R. Clinical Epidemiology, Risk Factors, and Outcomes of Encephalitis in Older Adults. Clin Infect Dis 2020;70:2377-2385.
17. Zhai T, Fu ZL, Qiu YB, Chen Q, Luo D, Chen K. Application of combined cerebrospinal fluid physicochemical parameters to detect intracranial infection in neurosurgery patients. BMC Neurol 2020;20:213.
18. Chen Z, Wang N, Huang Y, Wang M. Clinical characteristics and cerebro-spinal fluid cytokine changes in patients with acquired immunodeficiency syndrome and central nervous system infection. Exp Ther Med 2019;18:523-530.
19. Hasbun R, Abrahams J, Jekel J, Quagliarello VJ. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med 2001;345:1727-1733.
20. van Crevel H, Hijdra A, de Gans J. Lumbar puncture and the risk of herniation: when should we first perform CT? J Neurol 2002;249:129-137.
21. Solomon T, Michael BD, Smith PE, Sanderson F, Davies NW, Hart IJ, Holland M, Easton A, Buckley C, Kneen R, Beeching NJ. Management of suspected viral encephalitis in adults--Association of British Neurologists and British Infection Association National Guidelines. J Infect 2012;64:347-373.
22. Dorsett M, Liang SY. Diagnosis and Treatment of Central Nervous System Infections in the Emergency Department. Emerg Med Clin North Am 2016;34:917-942.
23. Khatib U, van de Beek D, Lees JA, Brouwer MC. Adults with suspected central nervous system infection: A prospective study of diagnostic accuracy. J Infect 2017;74:1-9.
24. Dubot-Pérès A, Mayxay M, Phetsouvanh R, Lee SJ, Rattanavong S, Vongsouvath M, Davong V, Chansamouth V, Phommasone K, Moore C, Dittrich S, Lattana O, Sirisouk J, Phoumin P, Panyanivong P, Sengduangphachanh A, Sibounheuang B, Chanthongthip A, Simmalavong M, Sengdatka D, Seubsanith A, Keoluangkot V, Phimmasone P, Sisout K, Detleuxay K, Luangxay K, Phouangsouvanh I, Craig SB, Tulsiani SM, Burns MA, Dance DAB, Blacksell SD, de Lamballerie X, Newton PN. Management of Central Nervous System Infections, Vientiane, Laos, 2003-2011. Emerg Infect Dis 2019;25:898-910.
25. Xiao HY, Wang YX, Xu TD, Zhu HD, Guo SB, Wang Z, Yu XZ. Evaluation and treatment of altered mental status patients in the emergency department: Life in the fast lane. World J Emerg Med 2012;3:270-277.
26. Kekec Z, Senol V, Koc F, Seydaoglu G. Analysis of altered mental status in Turkey. Int J Neurosci 2008;118:609-617.
27. Leong LB, Jian KH, Vasu A, Seow E. Prospective study of patients with altered mental status: clinical features and outcome. Int J Emerg Med 2008;1:179-182.
28. Wofford JL, Loehr LR, Schwartz E. Acute cognitive impairment in elderly ED patients: etiologies and outcomes. Am J Emerg Med 1996;14:649-653.
29. Kanjilal S, Cho TA, Piantadosi A. Diagnostic Testing in Central Nervous System Infection. Semin Neurol 2019;39:297-311.

APA	AYAZ C, GÜRSOY f, AYDOS Ö, Ceylan S, GÜNER R (2023). Is Infectious Meningitis/Encephalitis a Notable Problem in Older Adults Admitted to Emergency Department with Altered Mental Status?. , 36 - 45. 10.4274/ejgg.galenos.2022.2022-10-2
Chicago	AYAZ CAGLAYAN MERVE,GÜRSOY fahriye melis,AYDOS ÖMER,Ceylan Serdar,GÜNER RAHMET Is Infectious Meningitis/Encephalitis a Notable Problem in Older Adults Admitted to Emergency Department with Altered Mental Status?. (2023): 36 - 45. 10.4274/ejgg.galenos.2022.2022-10-2
MLA	AYAZ CAGLAYAN MERVE,GÜRSOY fahriye melis,AYDOS ÖMER,Ceylan Serdar,GÜNER RAHMET Is Infectious Meningitis/Encephalitis a Notable Problem in Older Adults Admitted to Emergency Department with Altered Mental Status?. , 2023, ss.36 - 45. 10.4274/ejgg.galenos.2022.2022-10-2
AMA	AYAZ C,GÜRSOY f,AYDOS Ö,Ceylan S,GÜNER R Is Infectious Meningitis/Encephalitis a Notable Problem in Older Adults Admitted to Emergency Department with Altered Mental Status?. . 2023; 36 - 45. 10.4274/ejgg.galenos.2022.2022-10-2
Vancouver	AYAZ C,GÜRSOY f,AYDOS Ö,Ceylan S,GÜNER R Is Infectious Meningitis/Encephalitis a Notable Problem in Older Adults Admitted to Emergency Department with Altered Mental Status?. . 2023; 36 - 45. 10.4274/ejgg.galenos.2022.2022-10-2
IEEE	AYAZ C,GÜRSOY f,AYDOS Ö,Ceylan S,GÜNER R "Is Infectious Meningitis/Encephalitis a Notable Problem in Older Adults Admitted to Emergency Department with Altered Mental Status?." , ss.36 - 45, 2023. 10.4274/ejgg.galenos.2022.2022-10-2
ISNAD	AYAZ, CAGLAYAN MERVE vd. "Is Infectious Meningitis/Encephalitis a Notable Problem in Older Adults Admitted to Emergency Department with Altered Mental Status?". (2023), 36-45. https://doi.org/10.4274/ejgg.galenos.2022.2022-10-2

APA	AYAZ C, GÜRSOY f, AYDOS Ö, Ceylan S, GÜNER R (2023). Is Infectious Meningitis/Encephalitis a Notable Problem in Older Adults Admitted to Emergency Department with Altered Mental Status?. European journal of geriatrics and gerontology (Online), 5(1), 36 - 45. 10.4274/ejgg.galenos.2022.2022-10-2
Chicago	AYAZ CAGLAYAN MERVE,GÜRSOY fahriye melis,AYDOS ÖMER,Ceylan Serdar,GÜNER RAHMET Is Infectious Meningitis/Encephalitis a Notable Problem in Older Adults Admitted to Emergency Department with Altered Mental Status?. European journal of geriatrics and gerontology (Online) 5, no.1 (2023): 36 - 45. 10.4274/ejgg.galenos.2022.2022-10-2
MLA	AYAZ CAGLAYAN MERVE,GÜRSOY fahriye melis,AYDOS ÖMER,Ceylan Serdar,GÜNER RAHMET Is Infectious Meningitis/Encephalitis a Notable Problem in Older Adults Admitted to Emergency Department with Altered Mental Status?. European journal of geriatrics and gerontology (Online), vol.5, no.1, 2023, ss.36 - 45. 10.4274/ejgg.galenos.2022.2022-10-2
AMA	AYAZ C,GÜRSOY f,AYDOS Ö,Ceylan S,GÜNER R Is Infectious Meningitis/Encephalitis a Notable Problem in Older Adults Admitted to Emergency Department with Altered Mental Status?. European journal of geriatrics and gerontology (Online). 2023; 5(1): 36 - 45. 10.4274/ejgg.galenos.2022.2022-10-2
Vancouver	AYAZ C,GÜRSOY f,AYDOS Ö,Ceylan S,GÜNER R Is Infectious Meningitis/Encephalitis a Notable Problem in Older Adults Admitted to Emergency Department with Altered Mental Status?. European journal of geriatrics and gerontology (Online). 2023; 5(1): 36 - 45. 10.4274/ejgg.galenos.2022.2022-10-2
IEEE	AYAZ C,GÜRSOY f,AYDOS Ö,Ceylan S,GÜNER R "Is Infectious Meningitis/Encephalitis a Notable Problem in Older Adults Admitted to Emergency Department with Altered Mental Status?." European journal of geriatrics and gerontology (Online), 5, ss.36 - 45, 2023. 10.4274/ejgg.galenos.2022.2022-10-2
ISNAD	AYAZ, CAGLAYAN MERVE vd. "Is Infectious Meningitis/Encephalitis a Notable Problem in Older Adults Admitted to Emergency Department with Altered Mental Status?". European journal of geriatrics and gerontology (Online) 5/1 (2023), 36-45. https://doi.org/10.4274/ejgg.galenos.2022.2022-10-2