Bacterial meningitis was found in 12 patients with nasopharyngeal
carcinoma, accounting for 0.65% of the 1850 patients with the tumour
diagnosed between 1981 and 1994 in our hospital. In 11 patients, the
time-lag between diagnosis of cancer and the appearance of infection ranged
from 9 months to 11 years (mean 57 months) whereas in one patient it was
only 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, especially
Pseudomonas aeruginosa, were the most common pathogens. Age, sex and
histopathology were not risk factors for infection. Conditions predisposing
to meningitis included intracranial invasion of the tumor, neutropenia,
otitis media, and neurosurgical procedures. All but two patients had
intracranial tumour invasion and erosion of the base of the skull. Local
spread of micro-organism to the meninges was more important than
haematogenous spread. The overall mortality in our patients was 66.7%, much
higher than in patients without cancer.
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