Abstract:

Background: Meningitis is one of the most common central nervous system (CNS) infection encountered worldwide. In Africa it is highly implicated to cause morbidity and mortality. The prevalence of meningitis is thought to be increasing due to the Human Immunodeficiency Virus (HIV) epidemic. The diagnosis of certain types of meningitis, particularly tuberculous meningitis (TBM) is sometimes difficult in resource-limited settings. Currently there is limited information on the etiologies, clinical characteristic and outcomes of meningitis among HV-infected patients in our setting.

Objective: To determine the laboratory-confirmed etiological agents, clinical characteristics and outcomes of meningitis among HIV-infected adults admitted to the medical wards of Bugando Medical Centre (BMC) for symptoms and signs of meningitis.

Methods: The study was a cross-sectional hospital based with prospective follow-up to determine 2 weeks in-hospital mortality. It included all HIV infected adults ≥18 years admitted to the medical wards of Bugando Medical Centre for symptoms and signs of meningitis. Socio-demographic and clinical information were collected using a standardized data collection tool. All enrolled patients underwent lumbar puncture and their CSF (cerebrospinal fluid) samples were sent to the laboratory to evaluate CSF parameters consistence with meningitis and confirm the etiology microbiologically. All results were provided to clinicians who decided about treatment for meningitis and other conditions.

Results: Among 60 HIV-infected adults clinically diagnosed to have meningitis in this study, 14 (23.3%) of them had a laboratory-confirmed etiology while 41 (68.3%) with CSF profile consistent with meningitis had no defined isolates. Of the laboratory-confirmed meningitis, Cryptococcus neoformans was the commonest cause of meningitis occurring in 11 (18.3%) patients. Mycobacterium tuberculosis was the second most common isolate with positive culture results in 4 patients (6.7%) while streptococcus pneumonia was isolated in one patient only. The mortality rate within 2 weeks of the hospital admission date was 20/55 (36.4%) among adult HIV-infected patients with meningitis and 2/5 (40.0%) among the patients without meningitis. The significant predictors of mortality were low baseline CD4 count and turbid CSF appearance.

Conclusion: Cryptococcal meningitis is the most prevalent laboratory-confirmed etiological agent among adult HIV-infected patients with suspected meningitis admitted at medical wards of Bugando Medical Centre. The diagnosis of meningitis through clinical features is a big challenge in HIV patients admitted with meningitis in our setting. Overall the mortality rate among this population with laboratory-confirmed meningitis is high and improving diagnosis may help to decrease the mortality rate.