OBJECTIVE: Indonesia has a concentrated but rapidly growing HIV epidemic. We examined the effect of HIV on causative organisms, clinical features and prognosis of adult meningitis. DESIGN: A prospective cohort study. METHODS: All adult patients at a referral hospital who underwent cerebrospinal fluid examination for suspected meningitis were examined for HIV and included in a prospective cohort study. Microbiological testing was done for common bacterial pathogens, mycobacteria and fungi. Patients were followed for at least 6 months, and logistic regression models were used to identify risk factors for mortality. RESULTS: Among 185 patients who mostly presented with subacute meningitis, 60% were male and the median age was 30 years. HIV infection was present in 25% of the patients; almost two-thirds were newly confirmed, and all presented with severe immunosuppression (median CD4 cell count 13/microl, range 2-98). One-third of HIV-infected patients had cryptococcal meningitis whereas two-thirds suffered from tuberculosis. After 1 month, 41% of patients had died. HIV infection was strongly associated with 1-month mortality (adjusted odds ratio 12.15; 95% confidence interval 3.04-15.72) and death during extended follow-up (hazard ratio 2.48; 95% confidence interval 1.97-5.74). CONCLUSION: Although HIV is still uncommon in the general population in Indonesia, its prevalence among adult meningitis cases already seems high. Mycobacterium tuberculosis and Cryptococcus neoformans are the main causes of meningitis in this setting, and mortality is very high, especially in HIV-infected patients. Our data suggest that adult meningitis cases in Indonesia should be screened routinely for HIV infection. Further studies are needed to address the high mortality.
OBJECTIVE: Indonesia has a concentrated but rapidly growing HIV epidemic. We examined the effect of HIV on causative organisms, clinical features and prognosis of adult meningitis. DESIGN: A prospective cohort study. METHODS: All adult patients at a referral hospital who underwent cerebrospinal fluid examination for suspected meningitis were examined for HIV and included in a prospective cohort study. Microbiological testing was done for common bacterial pathogens, mycobacteria and fungi. Patients were followed for at least 6 months, and logistic regression models were used to identify risk factors for mortality. RESULTS: Among 185 patients who mostly presented with subacute meningitis, 60% were male and the median age was 30 years. HIV infection was present in 25% of the patients; almost two-thirds were newly confirmed, and all presented with severe immunosuppression (median CD4 cell count 13/microl, range 2-98). One-third of HIV-infectedpatients had cryptococcal meningitis whereas two-thirds suffered from tuberculosis. After 1 month, 41% of patients had died. HIV infection was strongly associated with 1-month mortality (adjusted odds ratio 12.15; 95% confidence interval 3.04-15.72) and death during extended follow-up (hazard ratio 2.48; 95% confidence interval 1.97-5.74). CONCLUSION: Although HIV is still uncommon in the general population in Indonesia, its prevalence among adult meningitis cases already seems high. Mycobacterium tuberculosis and Cryptococcus neoformans are the main causes of meningitis in this setting, and mortality is very high, especially in HIV-infectedpatients. Our data suggest that adult meningitis cases in Indonesia should be screened routinely for HIV infection. Further studies are needed to address the high mortality.
Authors: José E Vidal; Juliana Gerhardt; Erique J Peixoto de Miranda; Rafi F Dauar; Gilberto S Oliveira Filho; Augusto C Penalva de Oliveira; David R Boulware Journal: Diagn Microbiol Infect Dis Date: 2012-05 Impact factor: 2.803
Authors: Henry Namme Luma; Benjamin Clet Nguenkam Tchaleu; Bertrand Hugo Mbatchou Ngahane; Elvis Temfack; Marie Solange Doualla; Marie Patrice Halle; Henry Achu Joko; Sinata Koulla-Shiro Journal: AIDS Res Ther Date: 2013-06-11 Impact factor: 2.250
Authors: Lidya Chaidir; Ahmad Rizal Ganiem; Adri Vander Zanden; Soni Muhsinin; Tina Kusumaningrum; Inri Kusumadewi; Andre van der Ven; Bachti Alisjahbana; Ida Parwati; Reinout van Crevel Journal: PLoS One Date: 2012-12-21 Impact factor: 3.240
Authors: A Rizal Ganiem; Sofiati Dian; Agnes Indriati; Lidya Chaidir; Rudi Wisaksana; Patrick Sturm; Willem Melchers; Andre van der Ven; Ida Parwati; Reinout van Crevel Journal: PLoS Negl Trop Dis Date: 2013-01-10