Epidemiologic and microbiologic characteristics of recurrent bacterial and fungal meningitis in the Netherlands, 1988-2005

Background. Patients may experience multiple episodes of bacterial meningitis. Information from large studies of recurrent meningitis is limited. We evaluated the incidence of recurrent bacterial meningitis and the distribution of causative organisms in The Netherlands. Methods. Data for patients with bacterial meningitis were prospectively collected nationwide for the period 1988-2005. Recurrent meningitis was defined as an episode of meningitis that either occurred >= 28 days after a previous episode or occurred <28 days after a previous episode but was caused by a different pathogen or different subtype of the same pathogen. Results. Of 18,915 patients, 202 (predominantly male) patients had recurrent bacterial meningitis (P <.01). Prevailing causative organisms were Streptococcus pneumoniae (40% of cases), Neisseria meningitidis (22%), and non-type b Haemophilus influenzae (9%). Pneumococci serotypes included in the heptavalent vaccine caused only 36% of cases of recurrent pneumococcal meningitis. The proportion of episodes caused by meningococcus serogroups W135, Y, and Z was higher among patients with recurrent meningitis than among those with nonrecurrent meningitis (odds ratio, 12.8), and the proportion caused by nontypeable and type f H. influenzae was also higher among patients with recurrent meningitis (odds ratio, 3.8 and 5.6, respectively). Conclusions. In The Netherlands, the prevalence of recurrent bacterial and fungal meningitis is low. The distribution of causative microorganisms differs between cases of recurrent meningitis and cases of nonrecurrent meningitis; this could be associated with vaccination