High mortality amongst adolescents and adults with bacterial meningitis in sub-Saharan Africa: an analysis of 715 cases from Malawi.
<h4>Unlabelled</h4>Mortality from bacterial meningitis in African adults is significantly higher than those in better resourced settings and adjunctive therapeutic interventions such as dexamethasone and glycerol have been shown to be ineffective. We conducted a study analysing data from...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2013-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0069783 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849724257395802112 |
|---|---|
| author | Emma C Wall Katharine Cartwright Matthew Scarborough Katherine M Ajdukiewicz Patrick Goodson James Mwambene Eduard E Zijlstra Stephen B Gordon Neil French Brian Faragher Robert S Heyderman David G Lalloo |
| author_facet | Emma C Wall Katharine Cartwright Matthew Scarborough Katherine M Ajdukiewicz Patrick Goodson James Mwambene Eduard E Zijlstra Stephen B Gordon Neil French Brian Faragher Robert S Heyderman David G Lalloo |
| author_sort | Emma C Wall |
| collection | DOAJ |
| description | <h4>Unlabelled</h4>Mortality from bacterial meningitis in African adults is significantly higher than those in better resourced settings and adjunctive therapeutic interventions such as dexamethasone and glycerol have been shown to be ineffective. We conducted a study analysing data from clinical trials of bacterial meningitis in Blantyre, Malawi to investigate the clinical parameters associated with this high mortality.<h4>Methods</h4>We searched for all clinical trials undertaken in Blantyre investigating bacterial meningitis from 1990 to the current time and combined the data from all included trial datasets into one database. We used logistic regression to relate individual clinical parameters to mortality. Adults with community acquired bacterial meningitis were included if the CSF culture isolate was consistent with meningitis or if the CSF white cell count was >100 cells/mm(3) (>50% neutrophils) in HIV negative participants and >5 cells/mm(3) in HIV positive participants. Outcome was measured by mortality at discharge from hospital (after 10 days of antibiotic therapy) and community follow up (day 40).<h4>Results</h4>Seven hundred and fifteen episodes of bacterial meningitis were evaluated. The mortality rate was 45% at day 10 and 54% at day 40. The most common pathogens were S.pneumoniae (84% of positive CSF isolates) and N.meningitidis (4%). 607/694 (87%) participants tested were HIV antibody positive. Treatment delays within the hospital system were marked. The median presenting GCS was 12/15, 17% had GCS<8 and 44.9% had a seizure during the illness. Coma, seizures, tachycardia and anaemia were all significantly associated with mortality on multivariate analysis. HIV status and pneumococcal culture positivity in the CSF were not associated with mortality. Adults with community acquired bacterial meningitis in Malawi present with a severe clinical phenotype. Predictors of high mortality are different to those seen in Western settings. Optimising in-hospital care and minimising treatment delays presents an opportunity to improve outcomes considerably. |
| format | Article |
| id | doaj-art-e2d89a5ad5cd4aabb1488009a3fad0d3 |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-e2d89a5ad5cd4aabb1488009a3fad0d32025-08-20T03:10:47ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-0187e6978310.1371/journal.pone.0069783High mortality amongst adolescents and adults with bacterial meningitis in sub-Saharan Africa: an analysis of 715 cases from Malawi.Emma C WallKatharine CartwrightMatthew ScarboroughKatherine M AjdukiewiczPatrick GoodsonJames MwambeneEduard E ZijlstraStephen B GordonNeil FrenchBrian FaragherRobert S HeydermanDavid G Lalloo<h4>Unlabelled</h4>Mortality from bacterial meningitis in African adults is significantly higher than those in better resourced settings and adjunctive therapeutic interventions such as dexamethasone and glycerol have been shown to be ineffective. We conducted a study analysing data from clinical trials of bacterial meningitis in Blantyre, Malawi to investigate the clinical parameters associated with this high mortality.<h4>Methods</h4>We searched for all clinical trials undertaken in Blantyre investigating bacterial meningitis from 1990 to the current time and combined the data from all included trial datasets into one database. We used logistic regression to relate individual clinical parameters to mortality. Adults with community acquired bacterial meningitis were included if the CSF culture isolate was consistent with meningitis or if the CSF white cell count was >100 cells/mm(3) (>50% neutrophils) in HIV negative participants and >5 cells/mm(3) in HIV positive participants. Outcome was measured by mortality at discharge from hospital (after 10 days of antibiotic therapy) and community follow up (day 40).<h4>Results</h4>Seven hundred and fifteen episodes of bacterial meningitis were evaluated. The mortality rate was 45% at day 10 and 54% at day 40. The most common pathogens were S.pneumoniae (84% of positive CSF isolates) and N.meningitidis (4%). 607/694 (87%) participants tested were HIV antibody positive. Treatment delays within the hospital system were marked. The median presenting GCS was 12/15, 17% had GCS<8 and 44.9% had a seizure during the illness. Coma, seizures, tachycardia and anaemia were all significantly associated with mortality on multivariate analysis. HIV status and pneumococcal culture positivity in the CSF were not associated with mortality. Adults with community acquired bacterial meningitis in Malawi present with a severe clinical phenotype. Predictors of high mortality are different to those seen in Western settings. Optimising in-hospital care and minimising treatment delays presents an opportunity to improve outcomes considerably.https://doi.org/10.1371/journal.pone.0069783 |
| spellingShingle | Emma C Wall Katharine Cartwright Matthew Scarborough Katherine M Ajdukiewicz Patrick Goodson James Mwambene Eduard E Zijlstra Stephen B Gordon Neil French Brian Faragher Robert S Heyderman David G Lalloo High mortality amongst adolescents and adults with bacterial meningitis in sub-Saharan Africa: an analysis of 715 cases from Malawi. PLoS ONE |
| title | High mortality amongst adolescents and adults with bacterial meningitis in sub-Saharan Africa: an analysis of 715 cases from Malawi. |
| title_full | High mortality amongst adolescents and adults with bacterial meningitis in sub-Saharan Africa: an analysis of 715 cases from Malawi. |
| title_fullStr | High mortality amongst adolescents and adults with bacterial meningitis in sub-Saharan Africa: an analysis of 715 cases from Malawi. |
| title_full_unstemmed | High mortality amongst adolescents and adults with bacterial meningitis in sub-Saharan Africa: an analysis of 715 cases from Malawi. |
| title_short | High mortality amongst adolescents and adults with bacterial meningitis in sub-Saharan Africa: an analysis of 715 cases from Malawi. |
| title_sort | high mortality amongst adolescents and adults with bacterial meningitis in sub saharan africa an analysis of 715 cases from malawi |
| url | https://doi.org/10.1371/journal.pone.0069783 |
| work_keys_str_mv | AT emmacwall highmortalityamongstadolescentsandadultswithbacterialmeningitisinsubsaharanafricaananalysisof715casesfrommalawi AT katharinecartwright highmortalityamongstadolescentsandadultswithbacterialmeningitisinsubsaharanafricaananalysisof715casesfrommalawi AT matthewscarborough highmortalityamongstadolescentsandadultswithbacterialmeningitisinsubsaharanafricaananalysisof715casesfrommalawi AT katherinemajdukiewicz highmortalityamongstadolescentsandadultswithbacterialmeningitisinsubsaharanafricaananalysisof715casesfrommalawi AT patrickgoodson highmortalityamongstadolescentsandadultswithbacterialmeningitisinsubsaharanafricaananalysisof715casesfrommalawi AT jamesmwambene highmortalityamongstadolescentsandadultswithbacterialmeningitisinsubsaharanafricaananalysisof715casesfrommalawi AT eduardezijlstra highmortalityamongstadolescentsandadultswithbacterialmeningitisinsubsaharanafricaananalysisof715casesfrommalawi AT stephenbgordon highmortalityamongstadolescentsandadultswithbacterialmeningitisinsubsaharanafricaananalysisof715casesfrommalawi AT neilfrench highmortalityamongstadolescentsandadultswithbacterialmeningitisinsubsaharanafricaananalysisof715casesfrommalawi AT brianfaragher highmortalityamongstadolescentsandadultswithbacterialmeningitisinsubsaharanafricaananalysisof715casesfrommalawi AT robertsheyderman highmortalityamongstadolescentsandadultswithbacterialmeningitisinsubsaharanafricaananalysisof715casesfrommalawi AT davidglalloo highmortalityamongstadolescentsandadultswithbacterialmeningitisinsubsaharanafricaananalysisof715casesfrommalawi |