Bacterial meningitis in patients with nasopharyngeal carcinoma

Bacterial meningitis was found in 12 patients with nasopharyngealcarcinoma, accounting for 0.65% of the 1850 patients with the tumourdiagnosed between 1981 and 1994 in our hospital. In 11 patients, thetime-lag between diagnosis of cancer and the appearance of infection rangedfrom 9 months to 11 years (mean 57 months) whereas in one patient it wasonly 5 days. Three patients developed mixed bacterial meningitis.Cerebrospinal fluid culture for bacteria was positive in six patients.Three patients (25%) were bacteraemic. Gram-negative bacilli, especiallyPseudomonas aeruginosa, were the most common pathogens. Age, sex andhistopathology were not risk factors for infection. Conditions predisposingto meningitis included intracranial invasion of the tumor, neutropenia,otitis media, and neurosurgical procedures. All but two patients hadintracranial tumour invasion and erosion of the base of the skull. Localspread of micro-organism to the meninges was more important thanhaematogenous spread. The overall mortality in our patients was 66.7%, muchhigher than in patients without cancer.