Clinical Presentation, Aetiology, and Outcomes of Meningitis in a Setting of High HIV and TB Prevalence

Meningitis causes significant morbidity and mortality globally. The aim of this study was to study the clinical presentation, aetiology, and outcomes of meningitis among adult patients admitted to Queen Mamohato Memorial Hospital in Maseru, Lesotho, with a diagnosis of meningitis. 

A cross-sectional study was conducted between February and April 2014; data collected included presenting signs and symptoms, laboratory results, and clinical outcomes. Descriptive statistics were used to summarise data; association between variables was analysed using Fisher's exact test. 56 patients were enrolled; the HIV coinfection rate was 79%. The most common presenting symptoms were altered mental status, neck stiffness, headache, and fever. TB meningitis was the most frequent diagnosis (39%), followed by bacterial (27%), viral (18%), and cryptococcal meningitis (16%). 

In-hospital mortality was 43% with case fatalities of 23%, 40%, 44%, and 90% for TB, bacterial, cryptococcal, and viral meningitis, respectively. Severe renal impairment was significantly associated with mortality. 

In conclusion, the causes of meningitis in this study reflect the high prevalence of HIV and TB in our setting. Strategies to reduce morbidity and mortality due to meningitis should include improving diagnostic services to facilitate early detection and treatment of meningitis and timely initiation of antiretroviral therapy in HIV-infected patients.

Table 3

Analysis of factors associated with in-hospital mortality.

	Survived	Died	p value (Fisher's exact test)
Age, years
>49	2	4	0.385
≤49	30	20
Gender
Male	14	10	1.000
Female	18	14
HIV status
Positive	23	21	0.436
Negative	5	2
CD4 count, cells/mm3
<100	7	7	0.715
≥100	9	6
Altered mental status
Yes	21	21	0.072
No	11	3
Seizures
Yes	3	1	0.627
No	29	23
Serum sodium, mmol/L
<130	11	5	0.750
≥130	18	12
eGFR, mL/min
<30	2	8	0.008
≥30	26	10

Full article at: http://goo.gl/iOZhTE

By: Thinyane KH1, Motsemme KM1, Cooper VJ2.

• 1Department of Pharmacy, National University of Lesotho, Roma 180, Lesotho.
• 2Department of Internal Medicine, Queen Mamohato Memorial Hospital, Maseru 100, Lesotho.  

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