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A Continuing Problem

P. Jan Geiseler, MD; Kenrad E. Nelson, MD; Stuart Levin, MD

Arch Neurol. 1981;38(12):749-753.

Abstract
• The clinical features and hospital course of 132 patients with purulent meningitis of unknown etiology (PMU) were compared with those of 1,032 patients with proven bacterial meningitis; all patients were admitted to a major referral center for meningitis treatment between 1954 and 1976. Most patients had no major underlying illnesses. Patients with PMU were more frequently older, "pretreated" with antibiotics, had longer duration of symptoms, evidenced less marked alterations of mental status, and died later in the hospitalization; however, the mortality and frequency of neurologic complications were similar to those in patients with bacterial meningitis. Patients with PMU who also had hemorrhagic rashes had fewer neurologic complications and none died; these patients comprised a distinct group in terms of better prognosis. New methods for rapid diagnosis of bacterial meningitis have only partially resolved the diagnostic dilemma of PMU.

Author Affiliations
From the Departments of Medicine (Dr Geiseler) and Preventive Medicine (Dr Nelson), University of Illinois Abraham Lincoln School of Medicine; the Department of Medicine (Dr Levin), Rush Medical College; and the Veterans Administration West Side Medical Center (Dr Geiseler), Chicago.

Footnotes
Accepted for publication Feb 14, 1981.

Reprint requests to Section of Infectious Diseases, West Side Veterans Administration Medical Center, MP151, PO Box 8195, 820 S Damen Ave, Chicago, IL 60680 (Dr Geiseler).

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