Mortality in adult patients with culture-positive and culture-negative meningitis in the Botswana national meningitis survey: a prevalent cohort study

Tenforde, Mark W; Mokomane, Margaret; Leeme, Tshepo; Tlhako, Nametso; Tsholo, Katlego; Chebani, Tony; Stephenson, Anya; Hutton, Jemima; Mitchell, Howard E.; Patel, Raju Kk; Hurt, William J; Pilatwe, Tlhagiso; Masupe, Tiny; Molefi, Mooketsi; Guthrie, Brandon L.; Farquhar, Carey; Mine, Madisa; Jarvis, Joseph N

doi:10.1016/s1473-3099(19)30066-0

Cited by 26 publications

(29 citation statements)

References 25 publications

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“…Restricting to studies after 2000, pooled short‐term mortality was 42% (95% CI: 25% to 59%, I 2 = 93%, seven studies). Ten‐week mortality from a national meningitis audit in Botswana of microbiologically confirmed cases was 46% (95% CI: 31% to 61%) . Long‐term mortality was reported in two studies, within one year in the study from Botswana and after completion of six months of antituberculous therapy in a Nigerian study , both studies with exclusively definite cases.…”

Section: Resultsmentioning

confidence: 98%

“…Short‐term mortality for 1008 cases was reported in 11 studies (two from a single hospital with combined patient outcomes in Uganda and two from a single hospital with combined outcomes in Zambia ; two‐week mortality specified in one study , in‐hospital mortality in ten studies with length of hospitalization not specified). Pooled mortality was 46% (95% CI: 33% to 59%, I 2 = 92%, 11 studies) (Figure ), and was higher in studies with only definite cases (51% (95% CI: 37% to 65%), I 2 = 78%, six studies) and mostly possible/probable cases (40% (95% CI: 23% to 59%), five studies).…”

Section: Resultsmentioning

confidence: 99%

“…Study quality was relatively low, with most studies not including details of ART or antituberculous treatment or average duration of hospitalization. Five included cases before 2000 [34,[109][110][111][112], whereas seven had a full period of observation after 2000 [53,60,67,107,108,113,114]. Eight countries were represented, with greatest representation from South Africa (three studies), Uganda (two studies) and Zambia (two studies).…”

Section: Tb Meningitis Outcomesmentioning

confidence: 99%

“…Several potential studies were excluded on fulltext review (Appendix S1): Reasons included TB case series, for example, exclusively multi-drug resistant cases [115][116][117], high risk of selection bias [42,[118][119][120], significant missingness of outcomes [121][122][123] and unknown or inadequate description of diagnostic criteria [50,74,[124][125][126]. Short-term mortality for 1008 cases was reported in 11 studies (two from a single hospital with combined patient outcomes in Uganda [53,113] and two from a single hospital with combined outcomes in Zambia [67,108]; two-week mortality specified in one study [114], in-hospital mortality in ten studies with length of hospitalization not specified). Pooled mortality was 46% (95% CI: 33% to 59%, I 2 = 92%, 11 studies) ( Figure 5), and was higher in studies with only definite cases (51% (95% CI: 37% to 65%), I 2 = 78%, six studies) and mostly possible/probable cases (40% (95% CI: 23% to 59%), five studies).…”

Section: Tb Meningitis Outcomesmentioning

confidence: 99%

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Mortality from HIV‐associated meningitis in sub‐Saharan Africa: a systematic review and meta‐analysis

et al. 2020

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Introduction HIV‐associated cryptococcal, TB and pneumococcal meningitis are the leading causes of adult meningitis in sub‐Saharan Africa (SSA). We performed a systematic review and meta‐analysis with the primary aim of estimating mortality from major causes of adult meningitis in routine care settings, and to contrast this with outcomes from clinical trial settings. Methods We searched PubMed, EMBASE and the Cochrane Library for published clinical trials (defined as randomized‐controlled trials (RCTs) or investigator‐managed prospective cohorts) and observational studies that evaluated outcomes of adult meningitis in SSA from 1 January 1990 through 15 September 2019. We performed random effects modelling to estimate pooled mortality, both in clinical trial and routine care settings. Outcomes were stratified as short‐term (in‐hospital or two weeks), medium‐term (up to 10 weeks) and long‐term (up to six months). Results and discussion Seventy‐nine studies met inclusion criteria. In routine care settings, pooled short‐term mortality from cryptococcal meningitis was 44% (95% confidence interval (95% CI):39% to 49%, 40 studies), which did not differ between amphotericin (either alone or with fluconazole) and fluconazole‐based induction regimens, and was twofold higher than pooled mortality in clinical trials using amphotericin based treatment (21% (95% CI:17% to 25%), 17 studies). Pooled short‐term mortality of TB meningitis was 46% (95% CI: 33% to 59%, 11 studies, all routine care). For pneumococcal meningitis, pooled short‐term mortality was 54% in routine care settings (95% CI:44% to 64%, nine studies), with similar mortality reported in two included randomized‐controlled trials. Few studies evaluated long‐term outcomes. Conclusions Mortality rates from HIV‐associated meningitis in SSA are very high under routine care conditions. Better strategies are needed to reduce mortality from HIV‐associated meningitis in the region.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Tb Meningitis Outcomesmentioning

confidence: 99%

Section: Tb Meningitis Outcomesmentioning

confidence: 99%

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Mortality from HIV‐associated meningitis in sub‐Saharan Africa: a systematic review and meta‐analysis

et al. 2020

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“…Standard CSF evaluation, following national laboratory protocols, remained unchanged during the study period and consisting of white cell count (WCC) and differential (lym phocytes, neutrophils) when WCC ≥10 cells/μL, protein and glucose, microscopy (gram stain, India ink), and bacterial and fungal culture. 13 The full work-up was incomplete for some patients (e.g. missing WCC, protein, or glucose), due to reagent stockout or incomplete laboratory recording.…”

Section: Study Design and Data Collectionmentioning

confidence: 99%

Epidemiology of adult meningitis during antiretroviral therapy scale-up in southern Africa: Results from the Botswana national meningitis survey

Tenforde

Mokomane

Leeme

et al. 2019

Journal of Infection

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s u m m a r yObjectives: 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) 20 0 0-2015 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 142.6/10 0,0 0 0 person-years (95%CI:138.3-147.1); incidence of CM was 25.0/10 0,0 0 0 (95%CI:23.2-26.9), and incidence of PM was 2.7/10 0,0 0 0 (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.

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Global Case Fatality of Bacterial Meningitis During an 80-Year Period

van Ettekoven,

Liechti,

Brouwer

et al. 2024

JAMA Netw Open

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ImportanceThe impact of vaccination, antibiotics, and anti-inflammatory treatment on pathogen distribution and outcome of bacterial meningitis over the past century is uncertain.ObjectiveTo describe worldwide pathogen distribution and case fatality ratios of community-acquired bacterial meningitis.Data SourcesGoogle Scholar and MEDLINE were searched in January 2022 using the search terms bacterial meningitis and mortality.Study SelectionIncluded studies reported at least 10 patients with bacterial meningitis and survival status. Studies that selected participants by a specific risk factor, had a mean observation period before 1940, or had more than 10% of patients with health care–associated meningitis, tuberculous meningitis, or missing outcome were excluded.Data Extraction and SynthesisData were extracted by 1 author and verified by a second author. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Random-effects models stratified by age (ie, neonates, children, adults), Human Development Index (ie, low-income or high-income countries), and decade and meta-regression using the study period’s year as an estimator variable were used.Main Outcome and MeasureCase fatality ratios of bacterial meningitis.ResultsThis review included 371 studies performed in 108 countries from January 1, 1935, to December 31, 2019, describing 157 656 episodes. Of the 33 295 episodes for which the patients’ sex was reported, 13 452 (40%) occurred in females. Causative pathogens were reported in 104 598 episodes with Neisseria meningitidis in 26 344 (25%) episodes, Streptococcus pneumoniae in 26 035 (25%) episodes, Haemophilus influenzae in 22 722 (22%), other bacteria in 19 161 (18%) episodes, and unidentified pathogen in 10 336 (10%) episodes. The overall case fatality ratio was 18% (95% CI, 16%-19%), decreasing from 32% (95% CI, 24%-40%) before 1961 to 15% (95% CI, 12%-19%) after 2010. It was highest in meningitis caused by Listeria monocytogenes at 27% (95% CI, 24%-31%) and pneumococci at 24% (95% CI, 22%-26%), compared with meningitis caused by meningococci at 9% (95% CI, 8%-10%) or H influenzae at 11% (95% CI, 10%-13%). Meta-regression showed decreasing case fatality ratios overall and stratified by S pneumoniae, Escherichia coli, or Streptococcus agalactiae (P &lt; .001).Conclusions and RelevanceIn this meta-analysis with meta-regression, declining case fatality ratios of community-acquired bacterial meningitis throughout the last century were observed, but a high burden of disease remained.

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Mortality in adult patients with culture-positive and culture-negative meningitis in the Botswana national meningitis survey: a prevalent cohort study

Cited by 26 publications

References 25 publications

Mortality from HIV‐associated meningitis in sub‐Saharan Africa: a systematic review and meta‐analysis

Mortality from HIV‐associated meningitis in sub‐Saharan Africa: a systematic review and meta‐analysis

Epidemiology of adult meningitis during antiretroviral therapy scale-up in southern Africa: Results from the Botswana national meningitis survey

Global Case Fatality of Bacterial Meningitis During an 80-Year Period

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