Etiology of Orphan Community-based Meningitis and Meningo-encephalitis.
Etiology of Orphan Community-based Meningitis and Meningo-encephalitis.
The primary purpose of this study is to assess the contribution of a non-invasive sampling
 (pharyngeal swab) in the diagnosis of community based meningitis or meningo-encephalitis.
Community-based meningitis and meningo-encephalitis are defined by the presence of more than
 10 leukocytes per mL of cerebrospinal fluid (CSF), eventually reported to the number of red
 blood cells. They can be associated with encephalitis, defined by cerebral or cerebellar
 dysfunction in the case of the transmission. The evolution includes death, what makes the
 seriousness of this clinical situation. However the diagnostic performance of meningitis and
 meningo-encephalitis in a patient without contact with a care structure is less than 25%
 resulting in empirical support in half of the patients. Indeed, the microbiological diagnosis
 of meningitis and transmission target currently only five pathogens including HIV positive
 resulted in a significant change to support the patient in three areas, decision of
 hospitalization, decision of isolation and antibiotic or antiviral treatment decision. A
 weekly epidemiological monitoring of the microbiological diagnosis of meningitis and
 meningo-encephalitis has enabled us to see a mismatch between a curve of requests for
 analyses and a flat curve of produced diagnoses. This discrepancy is interpreted as
 indicating a community outbreak of meningitis or meningo-encephalitis non-diagnosed by
 routine methods, called orphan meningitis or orphan meningo-encephalitis. On this
 observation, our research project is to improve the performance of the etiological diagnosis
 of community-based meningitis or meningo-encephalitis. To do this, we will evaluate the
 diagnostic performance of an advanced technique, using a non-invasive sample, the pharyngeal
 swab from the patient, to find micro-organisms that are not part of the commensal flora of
 the pharynx and who are responsible for undetected in routine meningitis. Indeed the main
 pathogens and meningitis (enterovirus, pneumococcus, meningococcus) transmission give a
 pharyngeal carriage before being responsible for meningitis or meningo-encephalitis. These
 bacteria are Coxiella burnetii, Bartonella spp., Tropheryma whipplei, Leptospira spp. and
 Borrelia spp.
Inclusion Criteria:

 -  Patient is aged more than 18 years old.

 -  Patient with clinical meningitis or meningo-encephalitis with community transmission.

 -  Patient with a prescription of microbiological diagnosis of meningitis or
 meningo-encephalitis.

 -  Patient who do not declined to have his medical records reviewed for research

 -  Patient with health insurance

 Exclusion Criteria:

 -  Minor Patient (age <18 years)

 -  Pregnant woman, parturient or breastfeeding

 -  Adult Patient under guardianship

 -  Patient deprived of liberty under court order

 -  Patient vital in emergency.