1. Epidemiology of adult meningitis during antiretroviral therapy scale-up in southern Africa: Results from the Botswana national meningitis survey.
- Author
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Tenforde MW, Mokomane M, Leeme T, Tlhako N, Tsholo K, Ramodimoosi C, Dube B, Mokobela KO, Tawanana E, Chebani T, Pilatwe T, Hurt WJ, Mitchell HK, Molefi M, Mullan PC, Guthrie BL, Farquhar C, Steenhoff AP, Mine M, and Jarvis JN
- Subjects
- Adult, Africa, Southern epidemiology, Age Factors, Antiretroviral Therapy, Highly Active, Biomarkers, Cross-Sectional Studies, Female, HIV Infections complications, HIV Infections diagnosis, HIV Infections drug therapy, HIV Infections virology, Humans, Incidence, Male, Meningitis, Cryptococcal diagnosis, Middle Aged, Public Health Surveillance, AIDS-Related Opportunistic Infections epidemiology, AIDS-Related Opportunistic Infections microbiology, Meningitis, Cryptococcal epidemiology, Meningitis, Cryptococcal microbiology
- 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., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2019
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