Impact of HIV infection on meningitis in Harare, Zimbabwe: a prospective study of 406 predominantly adult patients

Objective: To determine the causative organisms and characteristics of patients presenting with features of meningitis. Design: A prospective cross-sectional study. Setting: Two tertiary university-affiliate hospitals in Harare, Zimbabwe. Patients: Four-hundred and six patients clinically suspected to have meningitis. Main outcome measures: Causative organisms of meningitis; clinical and cerebrospinal fluid characteristics. Results: Four-hundred and six predominantly adult (95% were aged greater than or equal to 18 years) patients were suspected to have meningitis. Of the 200 patients confirmed to have meningitis, 89 (45%) had cryptococcal meningitis (CM), 54 (27%) had mononuclear meningitis (MM), 31 (16%) had pyogenic meningitis (PM), 24 (12%) had tuberculous meningitis (TBM) and 2 (1%) had undefined meningitis. HIV seropositivity was 100% in CM, 83% in MM, 81% in PM and 88% in TBM patients. In-hospital mortality rate was 38.8% for CM, 34.9% for MM, 68% for PM and 66.7% for TBM. HIV seropositivity was 80% in the 206 patients not found to have meningitis. Conclusions: All patients suspected to have meningitis had a high HIV sere positivity irrespective of whether they were later confirmed to have meningitis or not. CM was the most common type of meningitis seen. In-hospital mortality was high irrespective of the cause of meningitis. (C) 2000 Lippincott Williams & Wilkins.