{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T15:06:50Z","timestamp":1790435210946,"version":"4.1.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T00:00:00Z","timestamp":1614902400000},"content-version":"vor","delay-in-days":147,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"Netherlands Organization for Health Research and Development","doi-asserted-by":"crossref","award":[".17.308"],"award-info":[{"award-number":[".17.308"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001826","name":"Netherlands Organization for Health Research and Development","doi-asserted-by":"crossref","award":["918.19.627"],"award-info":[{"award-number":["918.19.627"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003180","name":"Academic Medical Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003180","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000781","name":"European Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000781","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Institute of Public Health and the Environmental Protection, Bilthoven","award":["IIR WI173197"],"award-info":[{"award-number":["IIR WI173197"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Recurrent bacterial meningitis has been found to occur in about 5% of meningitis cases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analyzed adults with recurrent episodes in a prospective nationwide cohort study of community-acquired bacterial meningitis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 2264 episodes of community-acquired bacterial meningitis between 2006 and 2018, 143 (6%) were identified as recurrent episodes in 123 patients. The median age was 57 years (interquartile range [IQR], 43\u201366), and 57 episodes (46%) occurred in men. The median duration between the first and the current episode was 5 years (IQR, 1\u201315). For 82 of 123 patients (67%), it was the first recurrent episode, 31 patients had 2\u20135 previous episodes (25%), 2 had 6\u201310 episodes (2%), and 2 had &amp;gt;10 episodes (2%). Predisposing factors were identified in 87 of 118 patients (74%) and most commonly consisted of ear or sinus infections (43 of 120, 36%) and cerebrospinal fluid leakage (37 of 116, 32%). The most common pathogens were Streptococcus pneumoniae (93 of 143, 65%) and Haemophilus influenzae (19 of 143, 13%). The outcome was unfavorable (Glasgow outcome scale score, &amp;lt;5) in 24 episodes with recurrent meningitis (17%) vs 810 for nonrecurrent meningitis patients (39%, P &amp;lt; .001). Six of 143 died (4%) vs 362 of 2095 patients (17%, P &amp;lt; .001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Recurrent meningitis occurs mainly in patients with ear or sinus infections and cerebrospinal fluid leakage. Predominant causative pathogens are S. pneumoniae and H. influenzae. The disease course is less severe, resulting in lower case fatality compared with nonrecurrent meningitis patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa1623","type":"journal-article","created":{"date-parts":[[2020,10,21]],"date-time":"2020-10-21T19:12:39Z","timestamp":1603307559000},"page":"e2545-e2551","source":"Crossref","is-referenced-by-count":18,"title":["Recurrent Community-Acquired Bacterial Meningitis in Adults"],"prefix":"10.1093","volume":"73","author":[{"given":"Liora","family":"ter Horst","sequence":"first","affiliation":[{"name":"Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, Amsterdam, The Netherlands; Amsterdam University Medical Centers, University of Amsterdam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthijs C","family":"Brouwer","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, Amsterdam, The Netherlands; Amsterdam University Medical Centers, University of Amsterdam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arie","family":"van der Ende","sequence":"additional","affiliation":[{"name":"Amsterdam University Medical Centers, University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity, Meibergdreef, Amsterdam, The Netherlands"},{"name":"Amsterdam University Medical Centers, University of Amsterdam, Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diederik","family":"van de Beek","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, Amsterdam, The Netherlands; Amsterdam University Medical Centers, University of Amsterdam"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,10,9]]},"reference":[{"key":"2021110300245284500_CIT0001","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/S1473-3099(15)00430-2","article-title":"Community-acquired bacterial meningitis in adults in the Netherlands, 2006\u201314: a prospective cohort study","volume":"16","author":"Bijlsma","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"2021110300245284500_CIT0002","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jinf.2016.04.009","article-title":"Neurological sequelae of bacterial meningitis","volume":"73","author":"Lucas","year":"2016","journal-title":"J Infect"},{"key":"2021110300245284500_CIT0003","doi-asserted-by":"crossref","first-page":"e46","DOI":"10.1086\/520682","article-title":"Community-acquired recurrent bacterial meningitis in adults","volume":"45","author":"Adriani","year":"2007","journal-title":"Clin Infect Dis"},{"key":"2021110300245284500_CIT0004","doi-asserted-by":"crossref","first-page":"2256","DOI":"10.1093\/cid\/ciz649","article-title":"Community-acquired bacterial meningitis in adults with cerebrospinal fluid leakage","volume":"70","author":"Ter Horst","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2021110300245284500_CIT0005","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1128\/CMR.00009-08","article-title":"Epidemiology, etiology, pathogenesis, and diagnosis of recurrent bacterial meningitis","volume":"21","author":"Tebruegge","year":"2008","journal-title":"Clin Microbiol Rev"},{"key":"2021110300245284500_CIT0006","first-page":"53","article-title":"Risk factors for community-acquired bacterial meningitis in adults","volume":"73","author":"Adriani","year":"2015","journal-title":"Neth J Med"},{"key":"2021110300245284500_CIT0007","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/j.ncl.2018.06.007","article-title":"Acute community-acquired bacterial meningitis","volume":"36","author":"Figueiredo","year":"2018","journal-title":"Neurol Clin"},{"key":"2021110300245284500_CIT0008","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.cmi.2019.04.032","article-title":"Resurgence of pneumococcal meningitis in Europe and Northern America","volume":"26","author":"Koelman","year":"2020","journal-title":"Clin Microbiol Infect"},{"key":"2021110300245284500_CIT0009","doi-asserted-by":"crossref","first-page":"S37","DOI":"10.1016\/j.cmi.2016.01.007","article-title":"ESCMID guideline: diagnosis and treatment of acute bacterial meningitis","volume":"22","author":"van de Beek","year":"2016","journal-title":"Clin Microbiol Infect"},{"key":"2021110300245284500_CIT0010","doi-asserted-by":"crossref","first-page":"2700","DOI":"10.1001\/jama.1989.03430190084036","article-title":"Differential diagnosis of acute meningitis. 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