期刊
PEDIATRIC INFECTIOUS DISEASE JOURNAL
卷 38, 期 9, 页码 906-911出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/INF.0000000000002396
关键词
pediatric meningitis; sub-Saharan Africa; Haemophilus; Pneumococcal Cryptococcus
资金
- Penn Center for AIDS Research, a National Institutes of Health (NIH) [P30 AI 045008]
- NIH Office of AIDS Research, Health Resources and Services Administration
- President's Emergency Plan for AIDS Relief [U91HA06801B]
- NIH National Institutes of Allergy and Infectious Disease [T32AI007044, F32AI140511]
- National Institute for Health Research [RP-2017-08-ST2-012]
- National Institutes of Health Research (NIHR) [RP-2017-08-ST2-012] Funding Source: National Institutes of Health Research (NIHR)
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.
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