Mark W Tenforde1, Margaret Mokomane2, Tshepo Leeme3, Nametso Tlhako3, Katlego Tsholo3, Chandapiwa Ramodimoosi4, Bonno Dube5, Kelebeletse O Mokobela5, Ephraim Tawanana6, Tony Chebani7, Tlhagiso Pilatwe7, William J Hurt3, Hannah K Mitchell3, Mooketsi Molefi8, Paul C Mullan9, Brandon L Guthrie10, Carey Farquhar11, Andrew P Steenhoff12, Madisa Mine2, Joseph N Jarvis13. 1. Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, 1959 Pacific Street NE, Seattle, WA 98195, USA; Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA; Botswana-UPenn Partnership, Gaborone, Botswana. Electronic address: mark.tenforde@gmail.com. 2. National Health Laboratory, Gaborone, Botswana. 3. Botswana-UPenn Partnership, Gaborone, Botswana. 4. National Tuberculosis Reference Laboratory, Gaborone, Botswana. 5. Nyangabwe Referral Hospital, Francistown, Botswana. 6. Selebi Phikwe Government Hospital, Selebi Phikwe, Botswana. 7. Botswana Ministry of Health and Wellness, Gaborone, Botswana. 8. University of Botswana, Gaborone, Botswana. 9. Children's Hospital of the King's Daughters, Norfolk, VA, USA. 10. Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, United States. 11. Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, 1959 Pacific Street NE, Seattle, WA 98195, USA; Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, United States. 12. Botswana-UPenn Partnership, Gaborone, Botswana; University of Botswana, Gaborone, Botswana; Division of Infectious Diseases & Global Health Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA. 13. Botswana-UPenn Partnership, Gaborone, Botswana; University of Botswana, Gaborone, Botswana; Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
Abstract
OBJECTIVES: Data on meningitis epidemiology in high HIV-prevalence African settings following antiretroviral therapy scale-up are lacking. We described epidemiology of adult meningitis in Botswana over a 16-year period. METHODS: Laboratory records for adults undergoing lumbar puncture (LP) 2000-2015 were collected, with complete national data 2013-2014. Cerebrospinal fluid (CSF) findings and linked HIV-data were described, and national incidence figures estimated for 2013-2014. Temporal trends in meningitis were evaluated. RESULTS: Of 21,560 adults evaluated, 41% (8759/21,560) had abnormal CSF findings with positive microbiological testing and/or pleocytosis; 43% (3755/8759) of these had no confirmed microbiological diagnosis. Of the 5004 microbiologically-confirmed meningitis cases, 89% (4432/5004) were cryptococcal (CM) and 8% (382/5004) pneumococcal (PM). Seventy-three percent (9525/13,033) of individuals undergoing LP with identifiers for HIV registry linkage had documented HIV-infection. Incidence of LP for meningitis evaluation in Botswana 2013-2014 was 142.6/100,000 person-years (95%CI:138.3-147.1); incidence of CM was 25.0/100,000 (95%CI:23.2-26.9), and incidence of PM was 2.7/100,000 (95%CI:2.4-3.1). In contrast to previously reported declines in CM incidence with ART roll-out, no significant temporal decline in pneumococcal or culture-negative meningitis was observed. CONCLUSIONS: CM remained the predominant identified aetiology of meningitis despite ART scale-up. A high proportion of cases had abnormal CSF with negative microbiological evaluation.
OBJECTIVES: Data on meningitis epidemiology in high HIV-prevalence African settings following antiretroviral therapy scale-up are lacking. We described epidemiology of adult meningitis in Botswana over a 16-year period. METHODS: Laboratory records for adults undergoing lumbar puncture (LP) 2000-2015 were collected, with complete national data 2013-2014. Cerebrospinal fluid (CSF) findings and linked HIV-data were described, and national incidence figures estimated for 2013-2014. Temporal trends in meningitis were evaluated. RESULTS: Of 21,560 adults evaluated, 41% (8759/21,560) had abnormal CSF findings with positive microbiological testing and/or pleocytosis; 43% (3755/8759) of these had no confirmed microbiological diagnosis. Of the 5004 microbiologically-confirmed meningitis cases, 89% (4432/5004) were cryptococcal (CM) and 8% (382/5004) pneumococcal (PM). Seventy-three percent (9525/13,033) of individuals undergoing LP with identifiers for HIV registry linkage had documented HIV-infection. Incidence of LP for meningitis evaluation in Botswana 2013-2014 was 142.6/100,000 person-years (95%CI:138.3-147.1); incidence of CM was 25.0/100,000 (95%CI:23.2-26.9), and incidence of PM was 2.7/100,000 (95%CI:2.4-3.1). In contrast to previously reported declines in CM incidence with ART roll-out, no significant temporal decline in pneumococcal or culture-negative meningitis was observed. CONCLUSIONS: CM remained the predominant identified aetiology of meningitis despite ART scale-up. A high proportion of cases had abnormal CSF with negative microbiological evaluation.
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