Spontaneous adult Gram-negative bacillary meningitis in Soweto, South Africa. (January 2015)

• Record Type: Journal Article
• Authors: Teckie, Gloria; Karstaedt, Alan
• Is Part Of: International journal of infectious diseases. Volume 30(2015:Jan.)
• Page Start: 38
• Page End: 40
• Publication Date: 2015-01
• Subjects: Gram-negative bacillary meningitis -- Adults -- Africa -- HIV; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2014.10.006
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Gram-negative bacillary meningitis disproportionately affected the HIV-infected. CSF white cells were commonly low or absent in the HIV-infected. Resistance to third-generation cephalosporins complicated management. Summary: Background: Gram-negative bacillary (GNB) meningitis is a rare cause of meningitis in adults and can occur as a spontaneous infection or as a complication of a neurosurgical procedure or trauma. We aimed to describe the characteristics and outcomes of adults with spontaneous GNB meningitis. Methods: A retrospective cohort analysis was performed of 26 patients with GNB meningitis seen at a single hospital in Soweto, South Africa. Results: A predisposing condition was found in 24 (92%) patients. The 19 (73%) HIV-infected patients had a median CD4 count of 24/mm 3 . Chronic renal disease, diabetes mellitus, myeloma, and alcoholism were other underlying conditions. The HIV-infected had a median cerebrospinal fluid (CSF) neutrophil count of 2/mm 3 compared to the HIV-non-infected of 560/mm 3 . Common organisms were Escherichia coli, Klebsiella pneumoniae, and non-typhoidal Salmonella in HIV-positive patients and K. pneumoniae in the HIV-negative group. Ten (38%) isolates were resistant to third-generation cephalosporins. Mortality was 65%. Conclusions: A disproportionate burden of GNB meningitis fell on the HIV-infected, among whom absent or low CSF white cells was common. Management was complicated by high rates of resistance to third-generation cephalosporins.