Original Research

Diagnostic and mortality outcomes in a cohort of adult meningitis suspects in KwaZulu-Natal

Onke Nonkala, Colleen Aldous, Douglas Wilson
Southern African Journal of Infectious Diseases | Vol 33, No 1 | a28 | DOI: https://doi.org/10.4102/sajid.v33i1.28 | © 2019 Onke Nonkala, Colleen Aldous, Douglas Wilson | This work is licensed under CC Attribution 4.0
Submitted: 13 May 2019 | Published: 31 March 2018

About the author(s)

Onke Nonkala, Department of Internal Medicine, Edendale Hospital, Pietermaritzburg, University of KwaZulu-Natal, Durban, South Africa
Colleen Aldous, School of Clinical Medicine, Nelson R Mandela (NRMSM) Campus, University of KwaZulu-Natal, Durban, South Africa
Douglas Wilson, School of Clinical Medicine, Nelson R Mandela (NRMSM) Campus, University of KwaZulu-Natal, Durban, South Africa

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Abstract

Background: The clinical value of lumbar puncture (LP) in settings with a high human immunodeficiency virus (HIV) prevalence has not been well defined.

Methods: We performed a retrospective chart review in 394 adults undergoing LP at a single regional level public-sector hospital in KwaZulu-Natal, South Africa.

Results: The median age of all the participants was 32.8 years (interquartile range 26.7; 41.2). Two hundred and fifty-five participants (64.7%) had an abnormal cerebrospinal fluid (CSF) analysis; 202 (79.5%) of whom were HIV seropositive. Sixty-four (25.1%) were diagnosed with tuberculosis meningitis and 62 (24.3%) tested positive for cryptococcal antigen. Thirty-three specimens grew Cryptococcus neoformans (32 tested antigen positive) and Streptococcus pneumonia was isolated in three specimens (0.8%). An abnormal CSF result was associated with increased risk of inpatient death (OR 3.8 [95% CI 1.7; 9.6]; p-value = 0.0004)

Conclusions: CSF abnormalities were common in this cohort of adults with suspected meningitis in KwaZulu-Natal, and were associated with increased odds of mortality in hospitalised participants.


Keywords

adult; cryptococcus; HIV; Meningitis; mortality; tuberculosis

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