In the MeninGene study, a nationwide observational cohort study in the Netherlands, we prospectively included 2022 episodes of community-acquired bacterial meningitis. We evaluated patients with bacterial meningitis associated with identified CSF leakage from a prospective nationwide cohort study in adults with community-acquired bacterial meningitis. Cerebrospinal fluid leakage has previously been reported in 3–8% of patients with community-acquired bacterial meningitis and in 38% of patients with recurrent meningitis. In patients with skull-base fracture due to head trauma, CSF leakage resolves spontaneously within 24 hours after onset, but once persistent, meningitis occurs in 7–30% of patients. Symptoms suggestive of CSF leakage include rhinorrhea and otorrhea, but CSF leakage may also go unnoticed. Bacterial meningitis in patients with CSF leakage can be classified as community acquired, in case of anatomic defects or contiguous spread of infection, or nosocomial or healthcare-associated meningitis after surgery for trauma. Anatomic defects can be caused by congenital abnormalities of the skull, through contiguous spread of infection during ear and sinus infections, or after neurosurgery, ear-nose-throat (ENT) surgery, or neurotrauma, which can all lead to cerebrospinal fluid (CSF) leakage. Risk factors for community-acquired bacterial meningitis include immunocompromise, distant foci of infection, and anatomic deficits in the natural barriers of the brain.

The outcome was unfavorable in 8 episodes (12%) and no patient died.Ĭerebrospinal fluid leakage, risk factor, bacterial meningitis Haemophilus influenzae was unencapsulated in all 10 episodes with known capsule type. The most common pneumococcal serotypes were 3 (4 episodes), 35B, 9N, 38, and 15C (each 2 episodes). Streptococcus pneumoniae was cultured in 33 episodes (51%) and H. Nine patients (38%) with known CSF leakage had been vaccinated (23-valent pneumococcal vaccine in 9 patients, meningococcal serogroup C vaccine in 2, meningococcal serogroup A and Haemophilus influenzae type b vaccine each in 1 patient). Of the recurrent episodes, 27 had known CSF leakage (71%) of whom 20 (53%) had previous surgery aiming to close the leak. The episode was a recurrent meningitis episode in 38 patients (59%). The cause of CSF leakage was identified in 49 of 65 episodes (75%), which most commonly consisted of ear-nose-throat surgery (19 of 49 episodes ) and remote head trauma (15 of 49 episodes ). CSF leakage was identified in 65 episodes of 2022 episodes (3%) in 53 patients.

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