Primary and opportunistic pathogens associated with meningitis in adults in Bangui, Central African Republic, in relation to human immunodeficiency virus serostatus

Abstract

Of the 276 patients enrolled, 215 (77.9%) were HIV positive. In HIV-positive patients cryptococcal meningitis (CM) was the most common cause of meningitis (39.1%) followed by pyogenic meningitis (PM) (30.7%), mononuclear meningitis (MM) (28.8%), and tuberculous meningitis (TM) (1.4%). In HIV-negative patients, PM was the most common cause (60.7%) followed by MM (37.7%) and CM (1.6%, one case). In-hospital mortality was higher in HIV-positive patients (73/128 = 57%) compared to those HIV negative (3/18 = 16.7%) (p = 0.001). Streptococcus pneumoniae (n = 26) was the most common bacterial diagnosis, mainly in HIV-positive patients (n = 22, 10.2%). Meningococcal meningitis (14 Neisseria meningitidis of group A and one W135) was diagnosed in nine (4.2%) HIV-positive and six (9.8%) HIV-negative patients. Gram-negative rods were isolated from five HIV-positive and two HIV-negative patients, respectively. The bacteria and fungi involved in meningitis did not display high levels of in vitro resistance. Conventional microbiology techniques failed to detect the causative agent in 55 (53.4%) PM cases. Broad-range bacterial PCR detected DNA from S. pneumoniae in three samples, N. meningitidis in two, Escherichia coli in one, Listeria monocytogenes in two and Staphylococcus aureus in one sample. In the CSF of five (three HIV negative and two HIV positive), PCR products were not identified with the oligonucleotide probes specific for the usual species of bacteria found in CSF, or genera commonly considered potential contaminants of clinical samples. Among the MM cases, 77 (90.5%) probable viral meningitis (54 HIV positive and 23 HIV negative) and eight TM (HIV positive) were suspected.

Bacterial and fungal etiologies of meningeal irritation syndrome in an emergency department

“…We did not isolate Neisseria meningitidis in this study; that could be explained by the fact that, bacteria are mainly involved in the cases of epidemics of meningitis in sahelian region of Cameroon. C. neoformans was the only microbe responsible of fungal meningitis, and in 40% of the cases of meningeal irritation syndrome from patients with AIDS; these results are in accordance with those of previous studies (Gordon et al, 2000;Roos, 2003;Millogo et al, 2004;Békondi et al, 2006), since Cryptococcal meningitis has been described as the most common life-threatening opportunistic fungal infection in patients with immune-compromised status.…”

CSF Study in 101 Cases of Neuro AIDS In Tertiary Hospital

“…14 cases (13.86%) had cryptococccal meningitis, 4 cases (3.9%) had pyogenic meningitis and 2 cases (1.9%) had fungal meningitis. Studies done by Bergemann A et al, 26 Bekondi C et al 27 and Likkittanasombut P at al 15 reported inflammatory CSF (increased protein, low sugar and pleocytosis in range of 0-2340×10 9 /l) in TBM patients. HIV infected individuals with TBM may therefore have a non inflammatory CSF characterstics.…”

“…The poor yield of Gram stain and culture, could be due the fact that these cases were on antibiotic treatment before hospital admission. 27 35 cases (34.64%) showed CT findings and 6 cases (5.9%) had MRI findings (3 cases of encephalitis, 1 case of cerebritis, 1 case of tuberculoma and 1 case of hydrocephalus).…”

Preventing Death from HIV-Associated Cryptococcal Meningitis: The Way Forward

“…Globally, there are an estimated 1 million CM cases each year, resulting in approximately 625,000 deaths [1•]. Most of these cases occur in sub-Saharan Africa; in many areas, it is the leading cause of meningitis in adults, responsible for up to 63% of all meningitis cases [2,3,5]. CM is also a common cause of mortality in HIV cohorts, accounting for 13% to 44% of deaths [32][33][34].…”

“…In many areas of sub-Saharan Africa and Southeast Asia, where HIV prevalence is high, it is the leading cause of meningitis in adults [2][3][4][5] and accounts for a large proportion of HIVrelated hospital admissions [6,7]. CM incidence has decreased in developed countries where highly active antiretroviral therapy (HAART) is widely available [8][9][10][11][12][13], but CM remains common in other areas of the world [1•].…”