Etiología de la meningitis aguda en adultos inmunocompetentes: Una revisión sistemática de estudios observacionales
Palabras clave:
meningitis, etiología, adulto, inmunocompetente, revisión sistemática, Streptococcus pneumoniae, herpesvirusResumen
Objetivo: Identificar y sintetizar la evidencia observacional reciente sobre los agentes etiológicos causantes de meningitis aguda comunitaria en adultos inmunocompetentes.
Métodos: Se realizó una revisión sistemática siguiendo las directrices PRISMA. Se ejecutaron búsquedas en PubMed y Scopus (hasta octubre de 2025) para identificar estudios observacionales (cohortes, transversales) que reportaran la prevalencia de patógenos en adultos (≥18 años) inmunocompetentes con meningitis aguda. Se excluyeron revisiones, reportes de caso, estudios en poblaciones pediátricas o inmunocomprometidas, y estudios de validación diagnóstica con alto riesgo de sesgo de selección. La síntesis de datos fue narrativa debido a la heterogeneidad clínica de los estudios.
Resultados: De 29 registros únicos identificados, 7 fueron evaluados a texto completo, resultando en la inclusión de 3 estudios observacionales (dos prospectivos, uno retrospectivo) que abarcaron 1316 pacientes de Países Bajos, Corea del Sur y Francia. En la meningitis bacteriana comunitaria (n = 696), Streptococcus pneumoniae (51 %) y Neisseria meningitidis (37 %) fueron los agentes predominantes, con una mortalidad asociada al neumococo del 30 %. En la meningitis aséptica/encefalitis (n = 471), los herpesvirus tratables fueron causas significativas, incluyendo el Virus Varicela-Zóster (VZV) (8,0 %) y el Virus Herpes Simple tipo 2 (HSV-2) (5,1 %). Se observó una brecha diagnóstica sustancial, con un 71,5 % de los casos de meningitis aséptica sin un herpesvirus identificado (nota: otros virus no fueron buscados sistemáticamente en esta cohorte).
Conclusión: La etiología de la meningitis en adultos inmunocompetentes sigue siendo un desafío heterogéneo. S. pneumoniae continúa siendo el principal patógeno bacteriano con alta mortalidad. Los herpesvirus (VZV, HSV-2) son causas virales tratables clave. La persistencia de una amplia brecha diagnóstica subraya la necesidad de adoptar tecnologías moleculares más amplias (p. ej., PCR multiplex, mNGS) y considerar etiologías no infecciosas.
Referencias
GBD 2019 Meningitis Antimicrobial Resistance Collaborators. Global, regional, and national burden of meningitis and its aetiologies, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol [Internet]. 2023 Aug;22(8):685–711. Available from: http://dx.doi.org/10.1016/s1474-4422(23)00195-3
Tsai CJ, Griffin MR, Nuorti JP, Grijalva CG. Changing epidemiology of pneumococcal meningitis after the introduction of pneumococcal conjugate vaccine in the United States. Clin Infect Dis [Internet]. 2008 Jun 1;46(11):1664–72. Available from: http://dx.doi.org/10.1086/587897
Koelman DLH, Brouwer MC, Ter Horst L, Bijlsma MW, van der Ende A, van de Beek D. Pneumococcal meningitis in adults: A prospective nationwide cohort study over a 20-year period. Clin Infect Dis [Internet]. 2022 Mar 1;74(4):657–67. Available from: http://dx.doi.org/10.1093/cid/ciab477
Block N, Naucler P, Wagner P, Morfeldt E, Henriques-Normark B. Bacterial meningitis: Aetiology, risk factors, disease trends and severe sequelae during 50 years in Sweden. J Intern Med [Internet]. 2022 Aug;292(2):350–64. Available from: http://dx.doi.org/10.1111/joim.13488
Zhao C, Zhang F, Wang Z, Yang S, Chen H, Wang H. Distribution of serotypes and antibiotic resistance profiles of Streptococcus pneumoniae in hospitalized adult patients: A retrospective multicenter surveillance in China (2018-2019) [Internet]. Research Square. 2025. Available from: http://dx.doi.org/10.21203/rs.3.rs-6513636/v1
Butić I, Gužvinec M, Jelić M, Groš I, Lucić S, Bošnjak M, et al. Serotype distribution and antimicrobial resistance of invasive Streptococcus pneumoniae isolates among Croatian adults during a fifteen-year period (2005-2019). Croat Med J [Internet]. 2022 Apr 30;63(2):156–65. Available from: http://dx.doi.org/10.3325/cmj.2022.63.156
Xing N, Zhao Z, Li Q, Dong Y, Li J, Zhang S. Ureaplasma parvum meningitis following atypical choroid plexus papilloma resection in an adult patient: a case report and literature review. BMC Infect Dis [Internet]. 2021 Dec 20;21(1):1276. Available from: http://dx.doi.org/10.1186/s12879-021-06975-y
Bai J, Cutler T. Drug-induced aseptic meningitis after amoxicillin use. JAAPA [Internet]. 2025 Apr 1;38(4):29–31. Available from: http://dx.doi.org/10.1097/01.jaa.0000000000000198
Farias LABG, Weyne LS, Landim LS, de Holanda PEL, Santos A da S, Cavalcanti LP de G, et al. Alterations and dynamics of major meningitis etiological agents during and post-COVID-19 pandemic: A systematic review. Trop Med Infect Dis [Internet]. 2025 Mar 18 [cited 2025 Oct 16];10(3):81. Available from: http://dx.doi.org/10.3390/tropicalmed10030081
Song P, Seok JM, Kim S, Choi J, Bae JY, Yu SN, et al. Viral etiology of aseptic meningitis and clinical prediction of herpes simplex virus type 2 meningitis. J Pers Med [Internet]. 2024 Sep 20 [cited 2025 Oct 16];14(9):998. Available from: http://dx.doi.org/10.3390/jpm14090998
Yu H, Liang D, Ding X, Gao H, Fan G, Song Y, et al. Comparison of microbial culture, metagenomic next-generation sequencing and droplet digital polymerase chain reaction methods for pathogen detection in patients with neurosurgical central nervous system infection. Front Cell Infect Microbiol [Internet]. 2025 Jul 30 [cited 2025 Oct 17];15(1606283):1606283. Available from: http://dx.doi.org/10.3389/fcimb.2025.1606283
Zhang M, Chen L, Zhao H, Qiao T, Jiang L, Wang C, et al. Metagenomic next-generation sequencing for diagnosis of infectious encephalitis and meningitis: a retrospective study of 90 patients. Neurol Res [Internet]. 2024 Feb [cited 2025 Oct 17];46(2):187–94. Available from: http://dx.doi.org/10.1080/01616412.2023.2265243
van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med [Internet]. 2004 Oct 28 [cited 2025 Oct 17];351(18):1849–59. Available from: http://dx.doi.org/10.1056/NEJMoa040845
Lee GH, Kim J, Kim HW, Cho JW. Herpes simplex viruses (1 and 2) and varicella-zoster virus infections in an adult population with aseptic meningitis or encephalitis: A nine-year retrospective clinical study: A nine-year retrospective clinical study. Medicine (Baltimore) [Internet]. 2021 Nov 19 [cited 2025 Oct 17];100(46):e27856. Available from: http://dx.doi.org/10.1097/MD.0000000000027856
Papin G, Bailly S, Dupuis C, Ruckly S, Gainnier M, Argaud L, et al. Clinical and biological clusters of sepsis patients using hierarchical clustering. PLoS One [Internet]. 2021 Aug 4 [cited 2025 Oct 17];16(8):e0252793. Available from: http://dx.doi.org/10.1371/journal.pone.0252793
Sharew B, Moges F, Yismaw G, Abebe W, Fentaw S, Vestrheim D, et al. Antimicrobial resistance profile and multidrug resistance patterns of Streptococcus pneumoniae isolates from patients suspected of pneumococcal infections in Ethiopia [Internet]. Research Square. Research Square; 2020. Available from: http://dx.doi.org/10.21203/rs.3.rs-120488/v1
Pinto TCA, Neves FPG, Souza ARV, Oliveira LMA, Costa NS, Castro LFS, et al. Evolution of penicillin non-susceptibility among streptococcus pneumoniae isolates recovered from asymptomatic carriage and invasive disease over 25 years in Brazil, 1990-2014. Front Microbiol [Internet]. 2019 Mar 14;10:486. Available from: http://dx.doi.org/10.3389/fmicb.2019.00486
Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Scheld WM, et al. 2017 infectious diseases society of America’s clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis [Internet]. 2017 Mar 15;64(6):701–6. Available from: http://dx.doi.org/10.1093/cid/cix152
Kamal F, Williams G, Akbar H, Khan MA, Kadaria D. Klebsiella pneumoniae liver abscess: A case report and review of literature. Cureus [Internet]. 2017 Jan 10;9(1):e970. Available from: http://dx.doi.org/10.7759/cureus.970
Sng CCA, Jap A, Chan YH, Chee SP. Risk factors for endogenous Klebsiella endophthalmitis in patients with Klebsiella bacteraemia: a case-control study. Br J Ophthalmol [Internet]. 2008 May;92(5):673–7. Available from: http://dx.doi.org/10.1136/bjo.2007.132522
Davis LE. Acute and recurrent viral meningitis. Curr Treat Options Neurol [Internet]. 2008 May;10(3):168–77. Available from: http://dx.doi.org/10.1007/s11940-008-0018-9
Shukla B, Aguilera EA, Salazar L, Wootton SH, Kaewpoowat Q, Hasbun R. Aseptic meningitis in adults and children: Diagnostic and management challenges. J Clin Virol [Internet]. 2017 Sep;94:110–4. Available from: http://dx.doi.org/10.1016/j.jcv.2017.07.016
Broberg EK, Simone B, Jansa J, EU/EEA Member State contributors. Upsurge in echovirus 30 detections in five EU/EEA countries, April to September, 2018. Euro Surveill [Internet]. 2018 Nov;23(44). Available from: http://dx.doi.org/10.2807/1560-7917.es.2018.23.44.1800537
MacIntyre C, Lourens C, Mendes A, de Villiers M, Avenant T, du Plessis NM, et al. West Nile virus, an underdiagnosed cause of acute fever of unknown origin and neurological disease among hospitalized patients in South Africa. Viruses [Internet]. 2023 Nov 2;15(11):2207. Available from: http://dx.doi.org/10.3390/v15112207
Bodilsen J, Storgaard M, Larsen L, Wiese L, Helweg-Larsen J, Lebech AM, et al. Infectious meningitis and encephalitis in adults in Denmark: a prospective nationwide observational cohort study (DASGIB). Clin Microbiol Infect [Internet]. 2018 Oct;24(10):1102.e1–1102.e5. Available from: http://dx.doi.org/10.1016/j.cmi.2018.01.016
Gundamraj V, Hasbun R. Viral meningitis and encephalitis: an update. Curr Opin Infect Dis [Internet]. 2023 Jun 1;36(3):177–85. Available from: http://dx.doi.org/10.1097/qco.0000000000000922
Qu C, Chen Y, Ouyang Y, Huang W, Liu F, Yan L, et al. Metagenomics next-generation sequencing for the diagnosis of central nervous system infection: A systematic review and meta-analysis. Front Neurol [Internet]. 2022 Sep 20;13:989280. Available from: http://dx.doi.org/10.3389/fneur.2022.989280
Zhang Y, Cui P, Zhang HC, Wu HL, Ye MZ, Zhu YM, et al. Clinical application and evaluation of metagenomic next-generation sequencing in suspected adult central nervous system infection. J Transl Med [Internet]. 2020 May 13;18(1):199. Available from: http://dx.doi.org/10.1186/s12967-020-02360-6
Miller S, Naccache SN, Samayoa E, Messacar K, Arevalo S, Federman S, et al. Laboratory validation of a clinical metagenomic sequencing assay for pathogen detection in cerebrospinal fluid. Genome Res [Internet]. 2019 May;29(5):831–42. Available from: http://dx.doi.org/10.1101/gr.238170.118
Edi VM, Rao P, Igo JO, Odega AS, Soladoye E, Ibeneme CN, et al. Mollaret’s syndrome: A case report. Cureus [Internet]. 2023 May;15(5):e38559. Available from: http://dx.doi.org/10.7759/cureus.38559
Querin LB, Martini WA, Parker BS. Recurrent aseptic (mollaret) meningitis: A case report. Cureus [Internet]. 2024 Oct;16(10):e72137. Available from: http://dx.doi.org/10.7759/cureus.72137
Wall EC, Mukaka M, Denis B, Mlozowa VS, Msukwa M, Kasambala K, et al. Goal directed therapy for suspected acute bacterial meningitis in adults and adolescents in sub-Saharan Africa. PLoS One [Internet]. 2017 Oct 27;12(10):e0186687. Available from: http://dx.doi.org/10.1371/journal.pone.0186687
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Derechos de autor 2025 Laisa Barbosa Griggio, Vanessa Silveira Akiyama, Thiago Suptil, Siveli Gabriela Montiel Vera, Sharla Albernaz Baiense Félix, Rafaela Pedroso, Leandro de Oliveira Vicente, Hellem Cristina Mendes Dourado, Gabriela Gonçalves Evangelista, Camilly Victoria Loio de Oliveira, Andrea Paola Britos Gómez
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
