The effect of HIV infection on paediatric bacterial meningitis in Blantyre, Malawi

Molyneux, Elizabeth; Tembo, Madalitso; Kayira, K; Bwanaisa, Lloyd; Mweneychanya, J.; Njobvu, Alfred; Forsyth, Hope; Rogerson, Sheryle; Walsh, Amanda L.; Molyneux, Malcolm E.

doi:10.1136/adc.88.12.1112

Cited by 56 publications

(49 citation statements)

References 19 publications

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“…Human immunodeficiency virus (HIV) infection was identified as being a predisposing factor in 43 (33%) cases, with all but 2 cases reported in a single study (135). The remaining 17 (13%) cases in this category consisted of individuals with agammaglobulinemia, immunoglobulin G (IgG) subclass deficiency, common variable immunodeficiency, interleukin-1 receptor-associated kinase 4 (IRAK-4) deficiency, and asplenia.…”

Section: Etiology Of Recurrent Bacterial Meningitismentioning

confidence: 99%

“…In an interesting study by Molyneux et al, which evaluated the effect of HIV infection on bacterial meningitis in a pediatric cohort in Malawi over a 3-year period, 64 episodes of recurrent meningitis were recorded (135). Strikingly, 68% of the recurrences of meningitis had occurred in HIV-positive children, representing only 34% of the study population.…”

Section: Acquired Immunodeficienciesmentioning

confidence: 99%

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Epidemiology, Etiology, Pathogenesis, and Diagnosis of Recurrent Bacterial Meningitis

2008

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SUMMARY Recurrent bacterial meningitis is a rare phenomenon and generally poses a considerable diagnostic challenge to the clinician. Ultimately, a structured approach and early diagnosis of any underlying pathology are crucial to prevent further episodes and improve the overall outcome for the affected individual. In this article, we are reviewing the existing literature on this topic over the last two decades, encompassing 363 cases of recurrent bacterial meningitis described in 144 publications. Of these cases, 214 (59%) were related to anatomical problems, 132 (36%) were related to immunodeficiencies, and 17 (5%) were related to parameningeal infections. The review includes a detailed discussion of the underlying pathologies and microbiological aspects as well as recommendations for appropriate diagnostic pathways for investigating this unusual entity.

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Section: Etiology Of Recurrent Bacterial Meningitismentioning

confidence: 99%

Section: Acquired Immunodeficienciesmentioning

confidence: 99%

Epidemiology, Etiology, Pathogenesis, and Diagnosis of Recurrent Bacterial Meningitis

2008

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“…Postneurosurgical meningitis caused by aerobic Gram-negative bacteria can occur late after surgery; the median time to the development of Acinetobacter meningitis after a neurosurgical procedure was found to be 12 days (range, 1 to 40 days) (285). Community-acquired meningitis due to aerobic Gram-negative bacteria is uncommon but can be found for immunocompromised patients, such as HIV-infected patients, but also neonates and the elderly (213,236,313). Clinical findings consist mostly of fever and altered consciousness (70).…”

Section: Aerobic Gram-negative Bacteriamentioning

confidence: 99%

“…Highly active antiretroviral therapy (HAART) reduces this risk but leaves it 35 times higher than that for meningitis patients without HIV infection (34,130,143). The increased risk of pneumococcal infections of HIV-infected patients has a profound impact in low-resource countries, where up to 95% of patients with pneumococcal meningitis have been reported to be HIV positive (128,129,176,198,213). The clinical presentations of HIV-positive and HIV-negative patients with bacterial meningitis are similar (198,213), although one study reported a higher seizure rate among HIV-positive patients (236).…”

Section: Immunocompromised Statementioning

confidence: 99%

Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis

2010

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SUMMARY The epidemiology of bacterial meningitis has changed as a result of the widespread use of conjugate vaccines and preventive antimicrobial treatment of pregnant women. Given the significant morbidity and mortality associated with bacterial meningitis, accurate information is necessary regarding the important etiological agents and populations at risk to ascertain public health measures and ensure appropriate management. In this review, we describe the changing epidemiology of bacterial meningitis in the United States and throughout the world by reviewing the global changes in etiological agents followed by specific microorganism data on the impact of the development and widespread use of conjugate vaccines. We provide recommendations for empirical antimicrobial and adjunctive treatments for clinical subgroups and review available laboratory methods in making the etiological diagnosis of bacterial meningitis. Finally, we summarize risk factors, clinical features, and microbiological diagnostics for the specific bacteria causing this disease.

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“…Regarding the study of Molyneux et al (25) , the high prevalence of HIV infection (approximately 26%), although similar between the two groups, dexamethasone and placebo, could act as a confounding factor. In a subgroup analysis published separately from their own study, Molyneux et al (33) demonstrated that mortality was higher in BM patients with HIV seropositivity (p<0.00001), although HIV status did not make a significant difference in the incidence of neurological sequelae. It is noteworthy that the effectiveness of dexamethasone in HIV patients was not a primary outcome for the study and, therefore, the value of this data is limited.…”

Section: Discussionmentioning

confidence: 99%

Revisão sistemática do uso da dexametasona como terapia adjuvante na meningite bacteriana em crianças

Prats

Gaspar

Ribeiro

et al. 2012

Rev. paul. pediatr.

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Revisão sistemática do uso da dexametasona como terapia adjuvante na meningite bacteriana em criançasRevisión sistemática del uso de la dexametasona como terapia adyuvante en la meningitis bacteriana en niños João Antonio G. G ABSTRACTObjective: To analyze the best available evidence from the last 15 years on the benefits of adjuvant therapy with dexamethasone for bacterial meningitis in children.Data sources: Randomized controlled trials comparing dexamethasone to placebo and/or other adjuvant therapies in patients with bacterial meningitis diagnosed by biochemical, cytological and/or microbiological data. Studies with patients from 29 days to 18 years of age, from 1996 to 2011, were searched at Medline, Lilacs and SciELO databases. The evaluated outcomes were mortality and development of neurological and/or hearing impairment. Studies related to tuberculous meningitis were excluded.Data synthesis: With the specified criteria, five published studies were identified corresponding to four study protocols. None of the studies showed differences between dexamethasone and placebo for the evaluated outcomes. All analyzed studies had high methodological quality (Jadad et al score=5).Conclusions: Current evidence is insufficient to support routine adjuvant therapy with dexamethasone to reduce mortality, hearing impairment, or neurological sequelae in pediatric patients with non-tuberculous bacterial meningitis.Key-words: meningitis, bacterial; dexamethasone; deafness; mortality. RESUMOObjetivo: Analisar a melhor evidência disponível nos últimos 15 anos com relação aos benefícios da terapia adjuvante com dexametasona na meningite bacteriana em população pediátrica.Fontes de dados: Das bases de dados Medline, Lilacs e SciELO, foram analisados ensaios clínicos randomizados de 1996 a 2011, os quais comparavam a dexametasona ao placebo e/ou a outra terapia adjuvante em pacientes com meningite bacteriana diagnosticada laboratorialmente por critérios quimiocitológicos e/ou bacteriológicos, na faixa etária de 29 dias aos 18 anos. Os desfechos avaliados foram mortalidade e ocorrência de sequelas neurológicas e/ou auditivas. Foram excluídos estudos relacionados à meningite tuberculosa.Síntese dos dados: Com os critérios utilizados, foram identificadas cinco publicações correspondentes a quatro protocolos de estudo. Nenhum dos estudos mostrou diferenças entre a dexametasona e o placebo para os desfechos avaliados. Os estudos analisados tiveram alta qualidade (escore de Jadad et al=5).Conclusões: As evidências encontradas na literatura são insuficientes para indicar de forma rotineira o uso da dexametasona como terapia adjuvante para redução de mortalidade, perda auditiva e sequelas neurológicas em pacientes pediátricos com meningite bacteriana não tuberculosa.Palavras-chave: meningite bacteriana; dexametasona; surdez; mortalidade. João Antonio G. G. Prats et al RESUMEN Objetivo:El presente estudio tiene por objetivo el análisis de la mejor evidencia disponible los últimos 15 años respecto a los beneficios de la terapia adyuvant...

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The effect of HIV infection on paediatric bacterial meningitis in Blantyre, Malawi

Cited by 56 publications

References 19 publications

Epidemiology, Etiology, Pathogenesis, and Diagnosis of Recurrent Bacterial Meningitis

Epidemiology, Etiology, Pathogenesis, and Diagnosis of Recurrent Bacterial Meningitis

Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis

Revisão sistemática do uso da dexametasona como terapia adjuvante na meningite bacteriana em crianças

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