{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T18:02:28Z","timestamp":1781373748913,"version":"3.54.1"},"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Acute meningitis remains a primary global health concern. Immunosuppressed patients have risks due to atypical clinical presentations and a broader range of causative pathogens. We aimed to describe the outcomes and clinical features of acute meningitis according to immunosuppression status. We performed a retrospective cohort study of adults with acute meningitis from January 2009 to December 2023. Patients with postsurgical meningitis were excluded. Outcomes and demographic, clinical, and laboratory features were compared using non-parametric statistical tests, and mortality was analyzed using multivariate logistic regression. Among 189 patients, 96 (51%) were immunosuppressed. The median age was lower in immunosuppressed patients (36 vs. 50 years, p\u2009&lt;\u20090.01). There were no differences in symptoms; the classical triad was present in only 21% vs. 19%. Immunosuppressed patients had lower CSF glucose levels (59% vs. 39%, p\u2009=\u20090.004). Overall mortality was 20%, with no significant difference by immune status. Independent predictors of death included age over 50 years (OR 2.9), altered mental status (OR 4.7), and bacterial meningitis (OR 2.3). Acute meningitis in immunosuppressed hosts shows attenuated inflammatory CSF profiles and a broader etiologic spectrum. Immunosuppression was not independently associated with in-hospital mortality.<\/jats:p>","DOI":"10.1371\/journal.pone.0344150","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T20:06:14Z","timestamp":1774382774000},"page":"e0344150","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes of acute meningitis according to immunosuppression status: 15-year retrospective cohort"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2509-618X","authenticated-orcid":true,"given":"Carla Marina","family":"Rom\u00e1n-Montes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria Alejandra","family":"P\u00e9rez-L\u00f3pez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nayeli Esmeralda","family":"Avalos-Celis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aranza","family":"Castillejos-Gracia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo","family":"Ponce de Le\u00f3n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8060-7301","authenticated-orcid":true,"given":"Guillermo Arturo","family":"Guaracha-Basa\u00f1ez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"issue":"3","key":"pone.0344150.ref001","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1097\/WCO.0000000000000934","article-title":"Acute bacterial meningitis","volume":"34","author":"EC Wall","year":"2021","journal-title":"Curr Opin Neurol"},{"key":"pone.0344150.ref002","doi-asserted-by":"crossref","first-page":"16074","DOI":"10.1038\/nrdp.2016.74","article-title":"Community-acquired bacterial meningitis","volume":"2","author":"D van de Beek","year":"2016","journal-title":"Nat Rev Dis Primers"},{"issue":"12","key":"pone.0344150.ref003","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1016\/S1474-4422(18)30387-9","article-title":"Global, regional, and national burden of meningitis, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016","volume":"17","author":"GBD 2016 Meningitis Collaborators","year":"2018","journal-title":"Lancet Neurol"},{"issue":"3","key":"pone.0344150.ref004","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1093\/cid\/cix806","article-title":"Lumbar Puncture Performed Promptly or After Neuroimaging in Acute Bacterial Meningitis in Adults: A Prospective National Cohort Study Evaluating Different Guidelines","volume":"66","author":"M Glim\u00e5ker","year":"2018","journal-title":"Clin Infect Dis"},{"issue":"2","key":"pone.0344150.ref005","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1007\/s11481-016-9705-6","article-title":"Bacterial Meningitis in Patients using Immunosuppressive Medication: a Population-based Prospective Nationwide Study","volume":"12","author":"KEB van Veen","year":"2017","journal-title":"J Neuroimmune Pharmacol"},{"issue":"8","key":"pone.0344150.ref006","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/S1473-3099(17)30243-8","article-title":"Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis","volume":"17","author":"R Rajasingham","year":"2017","journal-title":"Lancet Infect Dis"},{"issue":"7","key":"pone.0344150.ref007","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s11910-021-01119-w","article-title":"Central Nervous System Infections in Immunocompromised Patients","volume":"21","author":"AA Pruitt","year":"2021","journal-title":"Curr Neurol Neurosci Rep"},{"key":"pone.0344150.ref008","article-title":"Knowing the scope of meningococcal disease in Latin America","volume":"41","author":"MAP S\u00e1fadi","year":"2017","journal-title":"Rev Panam Salud Publica"},{"issue":"1","key":"pone.0344150.ref009","doi-asserted-by":"crossref","first-page":"103030","DOI":"10.1016\/j.jiph.2025.103030","article-title":"Pneumococcal meningitis in Mexico. 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