Ontology highlight
ABSTRACT: Objectives
Data on meningitis epidemiology in high HIV-prevalence African settings following antiretroviral therapy scale-up are lacking. We described epidemiology of adult meningitis in Botswana over a 16-year period.Methods
Laboratory records for adults undergoing lumbar puncture (LP) 2000-2015 were collected, with complete national data 2013-2014. Cerebrospinal fluid (CSF) findings and linked HIV-data were described, and national incidence figures estimated for 2013-2014. Temporal trends in meningitis were evaluated.Results
Of 21,560 adults evaluated, 41% (8759/21,560) had abnormal CSF findings with positive microbiological testing and/or pleocytosis; 43% (3755/8759) of these had no confirmed microbiological diagnosis. Of the 5004 microbiologically-confirmed meningitis cases, 89% (4432/5004) were cryptococcal (CM) and 8% (382/5004) pneumococcal (PM). Seventy-three percent (9525/13,033) of individuals undergoing LP with identifiers for HIV registry linkage had documented HIV-infection. Incidence of LP for meningitis evaluation in Botswana 2013-2014 was 142.6/100,000 person-years (95%CI:138.3-147.1); incidence of CM was 25.0/100,000 (95%CI:23.2-26.9), and incidence of PM was 2.7/100,000 (95%CI:2.4-3.1). In contrast to previously reported declines in CM incidence with ART roll-out, no significant temporal decline in pneumococcal or culture-negative meningitis was observed.Conclusions
CM remained the predominant identified aetiology of meningitis despite ART scale-up. A high proportion of cases had abnormal CSF with negative microbiological evaluation.
SUBMITTER: Tenforde MW
PROVIDER: S-EPMC6679721 | biostudies-literature | 2019 Sep
REPOSITORIES: biostudies-literature
Tenforde Mark W MW Mokomane Margaret M Leeme Tshepo T Tlhako Nametso N Tsholo Katlego K Ramodimoosi Chandapiwa C Dube Bonno B Mokobela Kelebeletse O KO Tawanana Ephraim E Chebani Tony T Pilatwe Tlhagiso T Hurt William J WJ Mitchell Hannah K HK Molefi Mooketsi M Mullan Paul C PC Guthrie Brandon L BL Farquhar Carey C Steenhoff Andrew P AP Mine Madisa M Jarvis Joseph N JN
The Journal of infection 20190628 3
<h4>Objectives</h4>Data on meningitis epidemiology in high HIV-prevalence African settings following antiretroviral therapy scale-up are lacking. We described epidemiology of adult meningitis in Botswana over a 16-year period.<h4>Methods</h4>Laboratory records for adults undergoing lumbar puncture (LP) 2000-2015 were collected, with complete national data 2013-2014. Cerebrospinal fluid (CSF) findings and linked HIV-data were described, and national incidence figures estimated for 2013-2014. Temp ...[more]