Causes of Pediatric Meningitis in Botswana : Results From a 16-Year National Meningitis Audit
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:38 |
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| Enthalten in: |
The Pediatric infectious disease journal - 38(2019), 9 vom: 01. Sept., Seite 906-911 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Mitchell, Hannah K [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 14.05.2020 Date Revised 14.05.2020 published: Print Citation Status MEDLINE |
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| doi: |
10.1097/INF.0000000000002396 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM298751097 |
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| 100 | 1 | |a Mitchell, Hannah K |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Causes of Pediatric Meningitis in Botswana |b Results From a 16-Year National Meningitis Audit |
| 264 | 1 | |c 2019 | |
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| 500 | |a Date Completed 14.05.2020 | ||
| 500 | |a Date Revised 14.05.2020 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Evaluation Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Research Support, U.S. Gov't, P.H.S. | |
| 650 | 7 | |a Anti-Retroviral Agents |2 NLM | |
| 650 | 7 | |a Haemophilus Vaccines |2 NLM | |
| 650 | 7 | |a Haemophilus influenzae type b polysaccharide vaccine |2 NLM | |
| 650 | 7 | |a Pneumococcal Vaccines |2 NLM | |
| 650 | 7 | |a Vaccines, Conjugate |2 NLM | |
| 700 | 1 | |a Mokomane, Margaret |e verfasserin |4 aut | |
| 700 | 1 | |a Leeme, Tshepo |e verfasserin |4 aut | |
| 700 | 1 | |a Tlhako, Nametso |e verfasserin |4 aut | |
| 700 | 1 | |a Tsholo, Katlego |e verfasserin |4 aut | |
| 700 | 1 | |a Ramodimoosi, Chandapiwa |e verfasserin |4 aut | |
| 700 | 1 | |a Dube, Bonno |e verfasserin |4 aut | |
| 700 | 1 | |a Mokobela, Kelebeletse O |e verfasserin |4 aut | |
| 700 | 1 | |a Tawanana, Ephraim |e verfasserin |4 aut | |
| 700 | 1 | |a Chebani, Tony |e verfasserin |4 aut | |
| 700 | 1 | |a Setlhake, Pretty |e verfasserin |4 aut | |
| 700 | 1 | |a Pilatwe, Tlhagiso |e verfasserin |4 aut | |
| 700 | 1 | |a Hurt, William J |e verfasserin |4 aut | |
| 700 | 1 | |a Molefi, Mooketsi |e verfasserin |4 aut | |
| 700 | 1 | |a Mullan, Paul C |e verfasserin |4 aut | |
| 700 | 1 | |a Steenhoff, Andrew P |e verfasserin |4 aut | |
| 700 | 1 | |a Mine, Madisa |e verfasserin |4 aut | |
| 700 | 1 | |a Jarvis, Joseph N |e verfasserin |4 aut | |
| 700 | 1 | |a Tenforde, Mark W |e verfasserin |4 aut | |
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