Bacterial and fungal etiologies of meningeal irritation syndrome in an emergency department

Meningeal irritation syndrome denotes to a range symptoms that require emergency management. Clinically, it is an expression of an irritation of the meninges combining with headache, fever, neck stiffness, altered consciousness and vomiting. The aim of this prospective study was to contribute to the management of medical emergencies. Cerebrospinal fluid (CSF) samples recovered from patients presenting signs of meningeal irritation syndrome were submitted to bacteriological, biochemical and fungal analyses. 2656 patients were received during the study period with 47 (1.8%), which had signs of meningeal irritation syndrome. 17% of cases were bacterial meningitis while 10.6% were fungal meningitis. Microbes isolated were Streptococcus pneumoniae, Streptococcus agalactiae, Haemophilus influenza and Cryptococcus neoformans. All bacteria were found to be sensitive to amoxicillin + clavulanic acid, gentamycin, chloramphenicol and ceftriaxone, and resistant to penicillin G, ampicillin and cotrimoxazol. All cases of cryptococcal meningitis were HIV (+) subjects. Other causes of meningeal irritation syndrome were HIV-related encephalitis (19.2%) and malaria (19.2%). Bacterial and fungal meningitis accounted for about 1/3 of the cases of meningeal irritation syndrome. The bacteria isolated presented a satisfactory sensitivity profile to the usual antibiotics. Although the prevalence of meningeal irritation syndrome appears to be low, it would be interesting to pay particular attention to it given the high representation of immunocompromised patients.