Patients with multiple myeloma who develop bacterial meningitis often face poor outcomes, according to study and review findings published recently in the International Journal of Infectious Diseases. A proactive approach may be beneficial to these patients while waiting on culture results and cerebrospinal fluid chemistry.

Multiple myeloma frequently leads to death soon after diagnosis, with infection responsible for half or more of those deaths. According to the investigators, bacterial meningitis occurs “relatively often” in multiple myeloma (they found 27 of 2306 occurrences of bacterial meningitis in myeloma patients), accounting for as much as 6.8% of infectious complications. Investigators sought to describe clinical features and outcomes of myeloma patients with bacterial meningitis and provide a literature review.

The researchers conducted a prospective cohort study between 2006 and 2018 in The Netherlands that included 2306 patients at least 17 years of age with multiple myeloma, of whom 27 had community-acquired bacterial meningitis. Cerebrospinal fluid (CSF) revealed 12 patients had a leukocyte count below 100/µL. They found the causative pathogen in 25 of the patients to be Streptococcus pneumoniae and 14 of the patients suffered unfavorable outcomes, 10 of whom died.


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In the literature review, the investigators saw 91 patients with multiple myeloma and bacterial meningitis, where their most common pathogen was also Streptococcus pneumoniae (35 of 48), and 4 patients of 20 died.

Researchers said their study limitations included selection bias. Additionally, patients discharged for meningitis and subsequently diagnosed with multiple myeloma were not included, and diagnosis of multiple myeloma may have been missed in those patients dying shortly after admission with bacterial meningitis.

The researchers found patients with multiple myeloma who develop bacterial meningitis face high rates of poor outcome, and often “present with a low CSF leukocyte count compared to bacterial meningitis in patients without multiple myeloma,” the investigators wrote in their report. They urged that “Physicians should have a low threshold to perform a lumbar puncture in myeloma patients and start antibiotic treatment pending CSF chemistry and culture results.”

Reference

Sheybani F, Brouwer MC, van de Beek D. Bacterial meningitis in patients with multiple myeloma: A prospective nationwide cohort study and review of the literature. Int J Infect Dis. Published online June 24, 2022. doi:10.1016/j.ijid.2022.06.038