Diagnostic and mortality outcomes in a cohort of adult meningitis suspects in KwaZulu-Natal. Issue 1 (2nd January 2018)

• Record Type: Journal Article
• Authors: Nonkala, Onke; Aldous, Colleen; Wilson, Douglas
• Is Part Of: Southern African journal of infectious diseases. Volume 33:Issue 1(2018)
• Page Start: 8
• Page End: 11
• Publication Date: 2018-01-02
• Subjects: adult -- cryptococcus -- HIV -- Meningitis -- mortality -- tuberculosis; Epidemiology -- Periodicals; Communicable diseases -- Periodicals; Sexually transmitted diseases -- Periodicals; 616.905
• DOI: 10.1080/23120053.2017.1371986
• Languages: English
• ISSNs: 2312-0053

Abstract

Abstract: Background: The clinical value of lumbar puncture (LP) in settings with a high human immunodeficiency virus (HIV) prevalence has not been well defined. Methods: We performed a retrospective chart review in 394 adults undergoing LP at a single regional level public-sector hospital in KwaZulu-Natal, South Africa. Results: The median age of all the participants was 32.8 years (interquartile range 26.7; 41.2). Two hundred and fifty-five participants (64.7%) had an abnormal cerebrospinal fluid (CSF) analysis; 202 (79.5%) of whom were HIV seropositive. Sixty-four (25.1%) were diagnosed with tuberculosis meningitis and 62 (24.3%) tested positive for cryptococcal antigen. Thirty-three specimens grew Cryptococcus neoformans (32 tested antigen positive) and Streptococcus pneumonia was isolated in three specimens (0.8%). An abnormal CSF result was associated with increased risk of inpatient death (OR 3.8 [95% CI 1.7; 9.6]; p -value = 0.0004) Conclusions: CSF abnormalities were common in this cohort of adults with suspected meningitis in KwaZulu-Natal, and were associated with increased odds of mortality in hospitalised participants.