The effect of HIV infection on paediatric bacterial meningitis in Blantyre, Malawi. Issue 12 (11th December 2003)

• Record Type: Journal Article
• Authors: Molyneux, E M; Tembo, M; Kayira, K; Bwanaisa, L; Mweneychanya, J; Njobvu, A; Forsyth, H; Rogerson, S; Walsh, A L; Molyneux, M E
• Is Part Of: Archives of disease in childhood. Volume 88:Issue 12(2003)
• Page Start: 1112
• Page End: 1118
• Publication Date: 2003-12-11
• Subjects: meningitis -- HIV -- outcome; Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/adc.88.12.1112
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aim: To compare presentation, progress, and outcome of acute bacterial meningitis in HIV seropositive and seronegative children. Methods: A double blind randomised placebo controlled study of the use of dexamethasone as adjuvant therapy in acute bacterial meningitis, in children aged 2 months to 13 years, was carried out from July 1997 to March 2001. A total of 598 children were enrolled, of whom 459 were tested for HIV serostatus. Results: Of the 459 children, 34% were HIV seropositive. Their presentation was similar to HIV seronegative children but more were shocked on arrival at hospital (33/157 v 12/302), and more had a focus of infection (85/157 v 57/302). HIV positive children had a higher incidence of Streptococcus pneumoniae infections (52% v 32%). Sixty four cases relapsed; 67% were in HIV positive patients. The mortality in HIV positive children was 65% compared with 36% in HIV negative children. The number of survivors in each group was similar. Hearing loss was more common in HIV negative than HIV positive children (66.3% v 47.2%). Steroid therapy had no influence on meningitis in HIV positive children, but the mortality in HIV negative children was 61% in children given steroids, and 39% in those who did not receive steroids. Conclusion: HIV seropositive children who develop bacterial meningitis have a high mortality and are prone to recurrent disease. There is an urgent need to prevent both primary and recurrent infections.