Adult meningitis in a setting of high HIV and TB prevalence: findings from 4961 suspected cases

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dc.contributor.authorJarvis, Josephen_ZA
dc.contributor.authorMeintjes, Graemeen_ZA
dc.contributor.authorWilliams, Anthonyen_ZA
dc.contributor.authorBrown, Yolandeen_ZA
dc.contributor.authorCrede, Tomen_ZA
dc.contributor.authorHarrison, Thomasen_ZA
dc.date.accessioned2015-11-11T11:57:23Z
dc.date.available2015-11-11T11:57:23Z
dc.date.issued2010en_ZA
dc.description.abstractBACKGROUND: The presentation and causes of adult meningitis in South Africa have changed substantially as a result of HIV. Knowledge of aetiology and laboratory findings in patients presenting with meningitis are important in guiding management. We performed a retrospective study to determine these findings in a setting of high HIV and TB prevalence in Cape Town. METHODS: Patients undergoing lumbar punctures between 1st January 2006 and 31st December 2008 at a public sector referral hospital were studied. Cases were classified by microbiological diagnosis, or in the absence of definitive microbiology as 1) normal CSF (neutrophils [less than or equal to] 1 x 106/L, lymphocytes [less than or equal to] 5 x 106/L, protein [less than or equal to] 0.5 g/dL, glucose [greater than or equal to]1.5 mmol/L), 2) minor abnormalities (neutrophils 2-5, lymphocytes 6-20, protein 0.51-1.0, glucose 1.0-1.49) or 3) markedly abnormal (neutrophils>5, lymphocytes>20, protein>1.0, glucose<1.0). RESULTS: 5578 LPs were performed on 4549 patients, representing 4961 clinical episodes. Of these, 2293 had normal CSF and 931 had minor abnormalities and no aetiology identified. Of the remaining 1737, microbiological diagnoses were obtained in 820 (47%). Cryptococcus accounted for 63% (514) of microbiological diagnoses, TB for 28% (227), bacterial meningitis for 8% (68). Of the remaining 917 who had marked abnormalities, the majority (59%) had a sterile lymphocytic CSF. Of note 16% (81) patients with confirmed Cryptococcus, 5% (12) with TB and 4% (3) with bacterial meningitis had normal CSF cell-counts and biochemistry. CONCLUSIONS: Cryptococcal and tuberculous meningitis are now the commonest causes of adult meningitis in this setting. TB meningitis is probably underdiagnosed by laboratory investigation, as evidence by the large numbers presenting with sterile lymphocytic markedly abnormal CSFs.en_ZA
dc.identifier.apacitationJarvis, J., Meintjes, G., Williams, A., Brown, Y., Crede, T., & Harrison, T. (2010). Adult meningitis in a setting of high HIV and TB prevalence: findings from 4961 suspected cases. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/14871en_ZA
dc.identifier.chicagocitationJarvis, Joseph, Graeme Meintjes, Anthony Williams, Yolande Brown, Tom Crede, and Thomas Harrison "Adult meningitis in a setting of high HIV and TB prevalence: findings from 4961 suspected cases." <i>BMC Infectious Diseases</i> (2010) http://hdl.handle.net/11427/14871en_ZA
dc.identifier.citationJarvis, J. N., Meintjes, G., Williams, A., Brown, Y., Crede, T., & Harrison, T. S. (2010). Adult meningitis in a setting of high HIV and TB prevalence: findings from 4961 suspected cases. BMC infectious diseases, 10(1), 67.en_ZA
dc.identifier.ris TY - Journal Article AU - Jarvis, Joseph AU - Meintjes, Graeme AU - Williams, Anthony AU - Brown, Yolande AU - Crede, Tom AU - Harrison, Thomas AB - BACKGROUND: The presentation and causes of adult meningitis in South Africa have changed substantially as a result of HIV. Knowledge of aetiology and laboratory findings in patients presenting with meningitis are important in guiding management. We performed a retrospective study to determine these findings in a setting of high HIV and TB prevalence in Cape Town. METHODS: Patients undergoing lumbar punctures between 1st January 2006 and 31st December 2008 at a public sector referral hospital were studied. Cases were classified by microbiological diagnosis, or in the absence of definitive microbiology as 1) normal CSF (neutrophils [less than or equal to] 1 x 106/L, lymphocytes [less than or equal to] 5 x 106/L, protein [less than or equal to] 0.5 g/dL, glucose [greater than or equal to]1.5 mmol/L), 2) minor abnormalities (neutrophils 2-5, lymphocytes 6-20, protein 0.51-1.0, glucose 1.0-1.49) or 3) markedly abnormal (neutrophils>5, lymphocytes>20, protein>1.0, glucose<1.0). RESULTS: 5578 LPs were performed on 4549 patients, representing 4961 clinical episodes. Of these, 2293 had normal CSF and 931 had minor abnormalities and no aetiology identified. Of the remaining 1737, microbiological diagnoses were obtained in 820 (47%). Cryptococcus accounted for 63% (514) of microbiological diagnoses, TB for 28% (227), bacterial meningitis for 8% (68). Of the remaining 917 who had marked abnormalities, the majority (59%) had a sterile lymphocytic CSF. Of note 16% (81) patients with confirmed Cryptococcus, 5% (12) with TB and 4% (3) with bacterial meningitis had normal CSF cell-counts and biochemistry. CONCLUSIONS: Cryptococcal and tuberculous meningitis are now the commonest causes of adult meningitis in this setting. TB meningitis is probably underdiagnosed by laboratory investigation, as evidence by the large numbers presenting with sterile lymphocytic markedly abnormal CSFs. DA - 2010 DB - OpenUCT DO - 10.1186/1471-2334-10-67 DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2010 T1 - Adult meningitis in a setting of high HIV and TB prevalence: findings from 4961 suspected cases TI - Adult meningitis in a setting of high HIV and TB prevalence: findings from 4961 suspected cases UR - http://hdl.handle.net/11427/14871 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14871
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2334-10-67
dc.identifier.vancouvercitationJarvis J, Meintjes G, Williams A, Brown Y, Crede T, Harrison T. Adult meningitis in a setting of high HIV and TB prevalence: findings from 4961 suspected cases. BMC Infectious Diseases. 2010; http://hdl.handle.net/11427/14871.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2010 Jarvis et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Infectious Diseasesen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcinfectdis/en_ZA
dc.subject.otherHIV Infectionsen_ZA
dc.subject.otherMeningitisen_ZA
dc.subject.otherTuberculosisen_ZA
dc.titleAdult meningitis in a setting of high HIV and TB prevalence: findings from 4961 suspected casesen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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