Epidemiology of meningitis in an HIV-infected Ugandan cohort

Radha Rajasingham, Joshua Rhein, Kate Klammer, Abdu Musubire, Henry Nabeta, Andrew Akampurira, Eric C. Mossel, Darlisha A. Williams, Dave J. Boxrud, Mary B. Crabtree, Barry R. Miller, Melissa A. Rolfes, Supatida Tengsupakul, Alfred O. Andama, David B. Meya, David R. Boulware

Research output: Contribution to journalArticlepeer-review

38 Scopus citations

Abstract

There is limited understanding of the epidemiology of meningitis among human immunodeficiency virus (HIV)-infected populations in sub-Saharan Africa. We conducted a prospective cohort study of HIV-infected adults with suspected meningitis in Uganda, to comprehensively evaluate the etiologies of meningitis. Intensive cerebrospiral fluid (CSF) testing was performed to evaluate for bacterial, viral, fungal, and mycobacterial etiologies, including neurosyphilis,16s ribosomal DNA (rDNA) polymerase chain reaction (PCR) for bacteria, Plex-ID broad viral assay, quantitative-PCR for HSV-1/2, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and Toxoplasma gondii; reverse transcription-PCR (RT-PCR) for Enteroviruses and arboviruses, and Xpert MTB/RIF assay. Cryptococcal meningitis accounted for 60% (188 of 314) of all causes of meningitis. Of 117 samples sent for viral PCR, 36% were EBV positive. Among cryptococcal antigen negative patients, the yield of Xpert MTB/RIF assay was 22% (8 of 36). After exclusion of cryptococcosis and bacterial meningitis, 61% (43 of 71) with an abnormal CSF profile had no definitive diagnosis. Exploration of new TB diagnostics and diagnostic algorithms for evaluation of meningitis in resource-limited settings remains needed, and implementation of cryptococcal diagnostics is critical.

Original languageEnglish (US)
Pages (from-to)274-279
Number of pages6
JournalAmerican Journal of Tropical Medicine and Hygiene
Volume92
Issue number2
DOIs
StatePublished - Feb 1 2015

Bibliographical note

Publisher Copyright:
Copyright © 2015 by The American Society of Tropical Medicine and Hygiene.

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