14 research outputs found
Cryptococcal meningitis: epidemiology, immunology, diagnosis and therapy.
HIV-associated cryptococcal meningitis is by far the most common cause of adult meningitis in many areas of the world that have high HIV seroprevalence. In most areas in Sub-Saharan Africa, the incidence of cryptococcal meningitis is not decreasing despite availability of antiretroviral therapy, because of issues of adherence and retention in HIV care. In addition, cryptococcal meningitis in HIV-seronegative individuals is a substantial problem: the risk of cryptococcal infection is increased in transplant recipients and other individuals with defects in cell-mediated immunity, and cryptococcosis is also reported in the apparently immunocompetent. Despite therapy, mortality rates in these groups are high. Over the past 5 years, advances have been made in rapid point-of-care diagnosis and early detection of cryptococcal antigen in the blood. These advances have enabled development of screening and pre-emptive treatment strategies aimed at preventing the development of clinical infection in patients with late-stage HIV infection. Progress in optimizing antifungal combinations has been aided by evaluation of the clearance rate of infection by using serial quantitative cultures of cerebrospinal fluid (CSF). Measurement and management of raised CSF pressure, a common complication, is a vital component of care. In addition, we now better understand protective immune responses in HIV-associated cases, immunogenetic predisposition to infection, and the role of immune-mediated pathology in patients with non-HIV associated infection and in the context of HIV-associated immune reconstitution reactions
Temporal and Spatial Dynamics of Monkeypox in Democratic Republic of Congo, 2000–2015
International audienc
The Epidemiology of Meningitis among Adults in a South African Province with a High HIV Prevalence, 2009-2012
S1 Table. Possible nosocomial and uncommon bacterial and fungal causes of meningitis
isolated fromCSF culture specimens among adults in Gauteng Province, 2009–2012. Possible
nosocomial and uncommon organisms do not usually cause community-acquiredmeningitis
but may cause meningitis due to the consequences of neurosurgical procedures or
dissemination following bacteraemia.As clinical and other laboratory parameters were not
available, we were unable to determine if these organisms were significant in causing meningitis.INTRODUCTION
Meningitis is a major cause of mortality in southern Africa. We aimed to describe the aetiologies
and frequencies of laboratory-confirmed fungal and bacterial meningitis among
adults in a South African province with an 11% HIV prevalence, over 4 years.
METHODS
We conducted a retrospective, observational study of secondary laboratory data, extracted
on all cerebrospinal fluid (CSF) specimens submitted to public-sector laboratories in Gauteng
province from 2009 through 2012. We calculated cause-specific incidence rates in the
general and HIV-infected populations and used Poisson regression to determine if trends
were significant.
RESULTS
We identified 11,891 (10.7%) incident cases of meningitis from 110,885 CSF specimens.
Cryptococcal meningitis, tuberculous meningitis and pneumococcal meningitis accounted
for 62.3% (n = 7,406), 24.6% (n = 2,928) and 10.1% (n = 1,197) of cases over the four-year
period. The overall incidence (cases per 100,000 persons) of cryptococcal meningitis
declined by 23% from 24.4 in 2009 to 18.7 in 2012 (p <0.001) and decreased by 19%
among HIV-infected persons from 178.2 to 144.7 (p <0.001). Tuberculous meningitis
decreased by 40% from 11.3 in 2009 to 6.8 in 2012 (p <0.001) and decreased by 36%
among HIV-infected persons from 54.4 to 34.9 (p <0.001). Pneumococcal meningitis
decreased by 41% from 4.2 in 2009 to 2.5 in 2012 (p <0.001) and decreased by 38% among HIV-infected persons from 28.0 to 17.5 (p <0.001). Among cases of other bacterial
meningitis (248/11,891, 2.1%), Neisseria meningitidis (n = 93), Escherichia coli (n = 72)
and Haemophilus influenzae (n = 20) were the most common organisms identified.
CONCLUSIONS
In this high HIV-prevalence province, cryptococcal meningitis was the leading cause of laboratory-
confirmed meningitis among adults. Over a 4-year period, there was a significant
decrease in incidence of cryptococcal, tuberculous and pneumococcal meningitis. This
coincided with expansion of the national antiretroviral treatment programme, enhanced
tuberculosis control programme and routine childhood immunisation with pneumococcal
conjugate vaccines.The South African Field Epidemiology Training Programme, the University of Pretoria,
US Centers for Disease Control and Prevention and the Centre for Opportunistic, Tropical and Hospital Infections at the National Institute for Communicable Diseases for training and financial support of the first author.http://www.plosone.orgam2016School of Health Systems and Public Health (SHSPH