Tenforde, Mark W; Mokomane, Margaret; Leeme, Tshepo; Tlhako, Nametso; Tsholo, Katlego; Ramodimoosi, Chandapiwa; Dube, Bonno; Mokobela, Kelebeletse O; Tawanana, Ephraim; Chebani, Tony; +10 more... Pilatwe, Tlhagiso; Hurt, William J; Mitchell, Hannah K; Molefi, Mooketsi; Mullan, Paul C; Guthrie, Brandon L; Farquhar, Carey; Steenhoff, Andrew P; Mine, Madisa; Jarvis, Joseph N; (2019) Epidemiology of adult meningitis during antiretroviral therapy scale-up in southern Africa: Results from the Botswana national meningitis survey. The Journal of infection, 79 (3). pp. 212-219. ISSN 0163-4453 DOI: https://doi.org/10.1016/j.jinf.2019.06.013
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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.
Item Type | Article |
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Faculty and Department | Faculty of Infectious and Tropical Diseases > Dept of Clinical Research |
PubMed ID | 31255634 |
Elements ID | 134068 |
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