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The Epidemiology of Meningitis among Adults in a South African Province with a High HIV Prevalence, 2009-2012

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ABSTRACT

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.

No MeSH data available.


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Number of cases and percentages of cryptococcal, tuberculous, pneumococcal and other bacterial meningitis among adults in Gauteng province, South Africa, 2009–2012 (n = 11,891).Mixed infections = a combination of any of the four groups of meningitis.
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pone.0163036.g003: Number of cases and percentages of cryptococcal, tuberculous, pneumococcal and other bacterial meningitis among adults in Gauteng province, South Africa, 2009–2012 (n = 11,891).Mixed infections = a combination of any of the four groups of meningitis.

Mentions: Table 2 illustrates the major pathogens identified from tested CSF specimens, stratified by year, and shows that the frequencies of all three leading pathogens decreased from 2009 through 2012. Among cases of other bacterial meningitis, the most common organisms identified were N. meningitidis (n = 93), Escherichia coli (n = 72) and Haemophilus influenzae (n = 20). There were 17 cases of Group-B Streptococcus infection over the four-year period. A total of 112 cases (0.9%) of mixed aetiology occurred, of which 95 cases were cryptococcal and tuberculous, six cases cryptococcal and pneumococcal, five cases of tuberculous and other bacterial (1 N. meningitidis, 2 E. coli, 1 H. influenzae, 1 Listeria monocytogenes), five cases of tuberculous and pneumococcal and one case of cryptococcal and other bacterial meningitis (E. coli). The rate of CSF collection decreased marginally from 2009 through 2011 (320 specimens per 100,000 persons to 313 specimens per 100,000 persons; p = 0.015) and increased in 2012 to 343 specimens per 100,000 persons (p<0.001). When comparing the relative proportions of pneumococcal and tuberculous to cryptococcal meningitis by year, cryptococcal increased relative to the declining proportions of pneumococcal and tuberculous meningitis (Fig 3).


The Epidemiology of Meningitis among Adults in a South African Province with a High HIV Prevalence, 2009-2012
Number of cases and percentages of cryptococcal, tuberculous, pneumococcal and other bacterial meningitis among adults in Gauteng province, South Africa, 2009–2012 (n = 11,891).Mixed infections = a combination of any of the four groups of meningitis.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036788&req=5

pone.0163036.g003: Number of cases and percentages of cryptococcal, tuberculous, pneumococcal and other bacterial meningitis among adults in Gauteng province, South Africa, 2009–2012 (n = 11,891).Mixed infections = a combination of any of the four groups of meningitis.
Mentions: Table 2 illustrates the major pathogens identified from tested CSF specimens, stratified by year, and shows that the frequencies of all three leading pathogens decreased from 2009 through 2012. Among cases of other bacterial meningitis, the most common organisms identified were N. meningitidis (n = 93), Escherichia coli (n = 72) and Haemophilus influenzae (n = 20). There were 17 cases of Group-B Streptococcus infection over the four-year period. A total of 112 cases (0.9%) of mixed aetiology occurred, of which 95 cases were cryptococcal and tuberculous, six cases cryptococcal and pneumococcal, five cases of tuberculous and other bacterial (1 N. meningitidis, 2 E. coli, 1 H. influenzae, 1 Listeria monocytogenes), five cases of tuberculous and pneumococcal and one case of cryptococcal and other bacterial meningitis (E. coli). The rate of CSF collection decreased marginally from 2009 through 2011 (320 specimens per 100,000 persons to 313 specimens per 100,000 persons; p = 0.015) and increased in 2012 to 343 specimens per 100,000 persons (p<0.001). When comparing the relative proportions of pneumococcal and tuberculous to cryptococcal meningitis by year, cryptococcal increased relative to the declining proportions of pneumococcal and tuberculous meningitis (Fig 3).

View Article: PubMed Central - PubMed

ABSTRACT

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 &lt;0.001) and decreased by 19% among HIV-infected persons from 178.2 to 144.7 (p &lt;0.001). Tuberculous meningitis decreased by 40% from 11.3 in 2009 to 6.8 in 2012 (p &lt;0.001) and decreased by 36% among HIV-infected persons from 54.4 to 34.9 (p &lt;0.001). Pneumococcal meningitis decreased by 41% from 4.2 in 2009 to 2.5 in 2012 (p &lt;0.001) and decreased by 38% among HIV-infected persons from 28.0 to 17.5 (p &lt;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.

No MeSH data available.


Related in: MedlinePlus