Meningitis is a disease subject to immediate compulsory notification, with outbreak potential. This study aimed to describe the clinical-epidemiological profile of meningitis cases and their etiologies in a tertiary teaching hospital in São Paulo between 2020 and 2024.

Retrospective descriptive study of meningitis cases identified and followed at a university hospital in São Paulo. Data sources were the Notifiable Diseases Information System (Sinan) and the institution’s medical records. Analyses were performed using Microsoft Excel®.

A total of 103 cases were notified. Mean age was 35 years (range 0–78), with predominance of males (57%). The most frequent signs and symptoms were fever (71%), headache (69%), neck stiffness (52%), vomiting (26%) and photophobia (24%). Seizures, petechiae and coma occurred in 4% of cases; classic meningeal signs in 3%. Among laboratory-confirmed cases, the most frequently identified etiologies were bacterial (62%), especially Streptococcus pneumoniae (26%), Neisseria meningitidis (19%) and Haemophilus influenzae (11%). In 35% of cases, it was not possible to identify the causative agent. Among patients, 18% were people living with HIV, 11% had active or previous tuberculosis, and 9% were under other forms of immunosuppression. Data on comorbidities were missing in 23% of cases. Regarding cerebrospinal fluid appearance, 42% were turbid, 36% clear, 4% purulent and in 3% there was no record. Clinical outcomes were: 63% discharged with complete recovery, 13% with neurological sequelae and 18% died; in 6% of cases, the outcome was not recorded.

There was a predominance of cases in male patients, adults, with typical symptoms such as fever, headache and neck stiffness. The most frequent etiology was bacterial, with a considerable percentage of cases without etiologic definition. The presence of comorbidities such as HIV and tuberculosis was relevant, as well as the high rate of deaths and neurological sequelae, reflecting disease severity. These findings reiterate the need for continuous epidemiological surveillance, early diagnosis and immediate therapeutic management. However, incomplete notification forms hindered more robust data analysis, compromising the effectiveness of public health actions.