Patients with multiple myeloma who develop bacterial meningitis often face poor outcomes, according to research published in the International Journal of Infectious Diseases.

The researchers noted that bacterial meningitis occurs “relatively often” in multiple myeloma, accounting for as much as 6.8% of infectious complications. The team 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. The causative pathogen in 25 of the patients was Streptococcus pneumoniae, and 14 of the patients suffered unfavorable outcomes, 10 of whom died.


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In the literature review, the researchers analyzed 91 patients with multiple myeloma and bacterial meningitis. The most common pathogen was again Streptococcus pneumoniae (35 of 48), and 4 patients of 20 died.

The researchers said this study was limited by 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 outcomes and often “present with a low CSF leukocyte count compared to bacterial meningitis in patients without multiple myeloma.”

“Physicians should have a low threshold to perform a lumbar puncture in myeloma patients and start antibiotic treatment pending CSF chemistry and culture results,” the researchers concluded.

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

This article originally appeared on Hematology Advisor