Mitchell, Hannah K; Mokomane, Margaret; Leeme, Tshepo; Tlhako, Nametso; Tsholo, Katlego; Ramodimoosi, Chandapiwa; Dube, Bonno; Mokobela, Kelebeletse O; Tawanana, Ephraim; Chebani, Tony; +9 more... Setlhake, Pretty; Pilatwe, Tlhagiso; Hurt, William J; Molefi, Mooketsi; Mullan, Paul C; Steenhoff, Andrew P; Mine, Madisa; Jarvis, Joseph N; Tenforde, Mark W; (2019) Causes of Pediatric Meningitis in Botswana: Results From a 16-Year National Meningitis Audit. PEDIATRIC INFECTIOUS DISEASE JOURNAL, 38 (9). pp. 906-911. ISSN 0891-3668 DOI: https://doi.org/10.1097/INF.0000000000002396
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Abstract
BACKGROUND: Central nervous system infections are an important cause of childhood morbidity and mortality in high HIV-prevalence settings of Africa. We evaluated the epidemiology of pediatric meningitis in Botswana during the rollout of antiretroviral therapy, pneumococcal conjugate vaccine and Haemophilus influenzae type B (HiB) vaccine. METHODS: We performed a cross-sectional study of children (<15 years old) evaluated for meningitis by cerebrospinal fluid (CSF) examination from 2000 to 2015, with complete national records for 2013-2014. Clinical and laboratory characteristics of microbiologically confirmed and culture-negative meningitis were described and incidence of Streptococcus pneumoniae, H. influenzae and cryptococcal meningitis was estimated for 2013-2014. RESULTS: A total of 6796 unique cases were identified. Median age was 1 year [interquartile range 0-3]; 10.4% (435/4186) of children with available HIV-related records were known HIV-infected. Overall, 30.4% (2067/6796) had abnormal CSF findings (positive microbiologic testing or CSF pleocytosis). Ten percent (651/6796) had a confirmed microbiologic diagnosis; including 26.9% (175/651) Cryptococcus, 18.9% (123/651) S. pneumoniae, 20.3% (132/651) H. influenzae and 1.1% (7/651) Mycobacterium tuberculosis. During 2013-2014, national cryptococcal meningitis incidence was 1.3 cases per 100,000 person-years (95% confidence interval, 0.8-2.1) and pneumococcal meningitis incidence 0.7 per 100,000 person-years (95% confidence interval, 0.3-1.3), with no HiB meningitis diagnosed. CONCLUSIONS: Following HiB vaccination, a marked decline in microbiologically confirmed cases of H. influenzae meningitis occurred. Cryptococcal meningitis remains the most common confirmed etiology, demonstrating gaps in prevention-of-mother-to-child transmission and early HIV diagnosis. The high proportion of abnormal CSF samples with no microbiologic diagnosis highlights limitation in available diagnostics.
Item Type | Article |
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Faculty and Department | Faculty of Infectious and Tropical Diseases > Dept of Clinical Research |
PubMed ID | 31261367 |
Elements ID | 134069 |
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