Pyogenic Meningitis in Patients with a History of Irradiation for Nasopharyngeal Carcinoma

Abstract

Background: Nasopharyngeal carcinoma (NPC) is a common cancer in the Southeast Asian territory. When patients with a history of NPC develop pyogenic meningitis, the overall mortality rate has been reported to be higher than those without NPC. Similar data from Hong Kong are lacking. Methods: Medical records of a total of 26 cases of pyogenic meningitis admitted to neurology ward, Queen Mary Hospital, from January 1997 to June 2008 were reviewed. The Glasgow Coma Scale (GCS) at presentation, time delay between admission and initiation of antibiotics, duration of hospital stay, Barthel Index (BI) upon discharge and immediate outcome were reviewed. Results: Mean age of the study cohort was 52.2 years, and the male-to-female ratio was 1.2:1. Five of the 26 cases had a history of NPC with irradiation prior to development of meningitis. The mean time lag between diagnosis of NPC to development of meningitis was 8 years (range, 1-23 years). There was no significant difference in GCS at presentation (15/15 in NPC group vs 13.8/15 in non-NPC group). Although there was a difference in time delay between admission and initiation of antibiotics (60.2 hours in NPC group vs 12.9 hours in non-NPC group), there was no difference in BI upon discharge (80/100 in NPC group vs 85.8/100 in non-NPC group) as well as in the duration of hospital stay (21.8 days in both groups). Mortality rate was 20% in NPC group (1/5) and 9.5% in non-NPC group (2/21). Conclusion: A history of NPC with irradiation does not seem to be a poor prognostic factor for patients with pyogenic meningitis. Outcome following rehabilitation is comparable between the two groups of survivors, irrespective of the history of irradiated NPC.