Clinical Profiles and Short-Term Outcomes of Adults with Presumptive Meningitis: A Prospective Observational Study

Abstract

Background: - Meningitis remains a significant burden in resource-limited settings, where diagnostic limitations often necessitate empiric management. This study evaluates clinical profiles and short-term outcomes of adult meningitis cases at Jimma University Medical Center (JUMC), Ethiopia, to identify actionable strategies for improving care. Methods: A hospital-based longitudinal study was conducted at JUMC (October 28, 2023, and February 24, 2025) involving adults aged ≥18 years managed for presumptive meningitis. Cerebrospinal fluid (CSF) analysis included Gram stain, culture, cell count, glucose, and protein. Clinical status, treatment, and outcomes were prospectively monitored via structured questionnaires and direct observation. Results: Among 284 patients, 95 (33.5%) met criteria for possible meningitis. Altered mental status (86.0%) and fever (51.4%) were predominant symptoms; classic meningeal signs (nuchal rigidity: 64.5%, Kernig’s sign: 43.5%) were inconsistently present. CSF analysis revealed acellular profiles in 40.1%, and 59.3% received pre-admission antibiotics. HIV co-infection (10.7% of tested patients) correlated with advanced immunosuppression (CD4+ <250 cells/μL: 81.8%) and higher mortality (24.0% vs. 12.6% overall). Empiric anti-tubercular therapy was initiated among forty patients. In-hospital mortality reached 12.6%, with unfavorable outcomes (27.7%) independently associated with delayed antibiotic initiation (adjusted odds ratio [AOR]=1.02 per hour delay) and cognitive impairment at presentation (AOR=1.32). Conclusion: This study underscores the challenges of meningitis management in resource limited settings, where low diagnostics and empiric overtreatment persist. HIV co-infection significantly worsens prognosis, necessitating integrated testing and CNS-focused protocols. Delayed antibiotic initiation and cognitive impairment predict poor outcomes, highlighting the urgency of early intervention. The frequent empiric use of anti-tubercular/antifungal therapies without confirmatory evidence necessitates expanded access to rapid molecular diagnostics. These findings advocate for context-specific guidelines, enhanced laboratory capacity, and prioritized care for high-risk groups to mitigate mortality and morbidity