Hannah K Mitchell1,2, Margaret Mokomane3, Tshepo Leeme1, Nametso Tlhako1, Katlego Tsholo1, Chandapiwa Ramodimoosi3, Bonno Dube4, Kelebeletse O Mokobela4, Ephraim Tawanana5, Tony Chebani6, Pretty Setlhake7, Tlhagiso Pilatwe6, William J Hurt1, Mooketsi Molefi7, Paul C Mullan8, Andrew P Steenhoff1,2, Madisa Mine3, Joseph N Jarvis1,7,9,10,11, Mark W Tenforde12,13. 1. From the Department of Clinical Research, Botswana-UPenn Partnership, Gaborone, Botswana. 2. Residency Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 3. Microbiology Department, Botswana National Health Laboratory, Gaborone, Botswana. 4. Microbiology Department, Nyangabwe Referral Hospital, Francistown, Botswana. 5. Microbiology Department, Selebi Phikwe Government Hospital, Selebi Phikwe, Botswana. 6. Botswana Ministry of Health, Gaborone, Botswana. 7. Department of Medicine, University of Botswana, Gaborone, Botswana. 8. Department for Pediatric Emergency Medicine, Children's Hospital of the King's Daughters, Norfolk, Virginia. 9. Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 10. Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom. 11. Department of Clinical Research, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana. 12. Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington. 13. Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington.
Abstract
BACKGROUND: Central nervous system infections are an important cause of childhood morbidity and mortality in high HIV-prevalence settings of Africa. We evaluated the epidemiology of pediatric meningitis in Botswana during the rollout of antiretroviral therapy, pneumococcal conjugate vaccine and Haemophilus influenzae type B (HiB) vaccine. METHODS: We performed a cross-sectional study of children (<15 years old) evaluated for meningitis by cerebrospinal fluid (CSF) examination from 2000 to 2015, with complete national records for 2013-2014. Clinical and laboratory characteristics of microbiologically confirmed and culture-negative meningitis were described and incidence of Streptococcus pneumoniae, H. influenzae and cryptococcal meningitis was estimated for 2013-2014. RESULTS: A total of 6796 unique cases were identified. Median age was 1 year [interquartile range 0-3]; 10.4% (435/4186) of children with available HIV-related records were known HIV-infected. Overall, 30.4% (2067/6796) had abnormal CSF findings (positive microbiologic testing or CSF pleocytosis). Ten percent (651/6796) had a confirmed microbiologic diagnosis; including 26.9% (175/651) Cryptococcus, 18.9% (123/651) S. pneumoniae, 20.3% (132/651) H. influenzae and 1.1% (7/651) Mycobacterium tuberculosis. During 2013-2014, national cryptococcal meningitis incidence was 1.3 cases per 100,000 person-years (95% confidence interval, 0.8-2.1) and pneumococcal meningitis incidence 0.7 per 100,000 person-years (95% confidence interval, 0.3-1.3), with no HiB meningitis diagnosed. CONCLUSIONS: Following HiB vaccination, a marked decline in microbiologically confirmed cases of H. influenzae meningitis occurred. Cryptococcal meningitis remains the most common confirmed etiology, demonstrating gaps in prevention-of-mother-to-child transmission and early HIV diagnosis. The high proportion of abnormal CSF samples with no microbiologic diagnosis highlights limitation in available diagnostics.
BACKGROUND:Central nervous system infections are an important cause of childhood morbidity and mortality in high HIV-prevalence settings of Africa. We evaluated the epidemiology of pediatric meningitis in Botswana during the rollout of antiretroviral therapy, pneumococcal conjugate vaccine and Haemophilus influenzae type B (HiB) vaccine. METHODS: We performed a cross-sectional study of children (<15 years old) evaluated for meningitis by cerebrospinal fluid (CSF) examination from 2000 to 2015, with complete national records for 2013-2014. Clinical and laboratory characteristics of microbiologically confirmed and culture-negative meningitis were described and incidence of Streptococcus pneumoniae, H. influenzae and cryptococcal meningitis was estimated for 2013-2014. RESULTS: A total of 6796 unique cases were identified. Median age was 1 year [interquartile range 0-3]; 10.4% (435/4186) of children with available HIV-related records were known HIV-infected. Overall, 30.4% (2067/6796) had abnormal CSF findings (positive microbiologic testing or CSF pleocytosis). Ten percent (651/6796) had a confirmed microbiologic diagnosis; including 26.9% (175/651) Cryptococcus, 18.9% (123/651) S. pneumoniae, 20.3% (132/651) H. influenzae and 1.1% (7/651) Mycobacterium tuberculosis. During 2013-2014, national cryptococcal meningitis incidence was 1.3 cases per 100,000 person-years (95% confidence interval, 0.8-2.1) and pneumococcal meningitis incidence 0.7 per 100,000 person-years (95% confidence interval, 0.3-1.3), with no HiB meningitis diagnosed. CONCLUSIONS: Following HiB vaccination, a marked decline in microbiologically confirmed cases of H. influenzaemeningitis occurred. Cryptococcal meningitis remains the most common confirmed etiology, demonstrating gaps in prevention-of-mother-to-child transmission and early HIV diagnosis. The high proportion of abnormal CSF samples with no microbiologic diagnosis highlights limitation in available diagnostics.
Authors: William J Hurt; Mark W Tenforde; Mooketsi Molefi; Hannah K Mitchell; Thandi Milton; Martin S Azama; Irene Goercke; Fredah Mulenga; Nametso Tlhako; Katlego Tsholo; Tuhina Srivastava; Tshepo B Leeme; Godfrey Simoonga; Charles Muthoga; Kwana Lechiile; Madisa Mine; Joseph N Jarvis Journal: Clin Infect Dis Date: 2021-05-18 Impact factor: 9.079
Authors: Alba Navarro-Flores; Jose Ernesto Fernandez-Chinguel; Niels Pacheco-Barrios; David R Soriano-Moreno; Kevin Pacheco-Barrios Journal: J Neurol Date: 2022-03-15 Impact factor: 4.849