Favorable Prognosis of Purulent Meningitis in Patients Infected with Human Immunodeficiency Virus

Almirante, Benito; Saballs, M.; Ribera, Esteban; Pigrau, Carles; Gavaldá, Joan; Gasser, I; Pahissa, Albert

doi:10.1086/514611

Cited by 29 publications

(16 citation statements)

References 23 publications

(6 reference statements)

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“…It is possible that concurrent HIV infection explains the high mortality rate in our series. However, recent data from Europe have shown that AIDS patients with meningitis do not have an mortality rate higher than patients without HIV infection [14]. In view of the fact that patients we studied did not have access to either antimicrobial prophylaxis or HIV therapy, it is not possible to usefully compare our population with theirs.…”

Section: Discussionmentioning

confidence: 95%

Bacterial Meningitis in Malawian Adults: Pneumococcal Disease is Common, Severe, and Seasonal

Gordon

Walsh

Chaponda

et al. 2000

Clinical Infectious Diseases

110

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We prospectively collected laboratory details and outcome data on all patients with laboratory-confirmed cases of meningitis that presented to our unit in Blantyre, Malawi, from 1 April 1998 through 31 March 1999. There were 502 patients with cases of meningitis; the most common causative organisms were Cryptococcus neoformans and Streptococcus pneumoniae. This pattern probably reflects the local human immunodeficiency virus (HIV) seroprevalence (31%) and is different from the pattern in 1974, when Neisseria meningitidis was the most common isolate. There has been an 8-fold increase in the number of meningitis cases per year since 1974, and a doubling of the percentage of medical admissions due to meningitis. The inpatient mortality rate among patients with cases of pneumococcal meningitis was 61%, and in the group as a whole was 41%. Despite the HIV-related pattern of infecting pathogens among these cases of meningitis and the increased incidence of the condition, there was evidence that the typical seasonal pattern of pneumococcal meningitis, which peaks in the cold, dry season, was preserved.

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Section: Discussionmentioning

confidence: 95%

Bacterial Meningitis in Malawian Adults: Pneumococcal Disease is Common, Severe, and Seasonal

Gordon

Walsh

Chaponda

et al. 2000

Clinical Infectious Diseases

110

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“…HIV is a risk factor for the development of invasive pneumococcal disease [28]. In addition, it has been suggested that the outcome of meningitis in HIV‐infected patients is better than that in HIV‐negative patients [29]. Finally, the authors of the Malawian RCT could not test the hypothesis of additional benefit from dexamethasone in patients with HIV because of the small sample of HIV negative patients (approximately 10% of the enrolled patients).…”

Section: Discussionmentioning

confidence: 99%

Adjunctive dexamethasone therapy for bacterial meningitis in adults: a meta‐analysis of randomized controlled trials

Vardakas

Matthaiou

Falagas

2009

Euro J of Neurology

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The objective of this review was to study the effectiveness of dexamethasone for the treatment of adult patients with bacterial meningitis. Data was extracted from randomized controlled trials (RCTs) comparing dexamethasone with placebo or no treatment and pooled using meta-analysis techniques. Treatment with dexamethasone was associated with a non-significant lower mortality than placebo or no treatment [odds ratio (OR) = 0.68, 95% confidence interval (CI) 0.45-1.04]. If a RCT conducted in Malawi was excluded from the analysis, dexamethasone was associated with lower mortality than placebo or no treatment (OR = 0.58, 95% CI 0.40-0.83). Dexamethasone was associated with lower mortality in patients with definite meningitis (OR = 0.55, 95% CI 0.31-0.96), short duration of symptoms (OR = 0.61, 95% CI 0.38-1.00), Streptococcus pneumoniae meningitis (OR = 0.26, 95% CI 0.08-0.78), patients in countries with high (OR = 0.45, 95% CI 0.23-0.87) and medium Human Development Index (OR = 0.65, 95% CI 0.42-1.00). No benefit was seen in patients with longer duration of symptoms (OR = 0.80, 95% CI 0.47-1.36) or no antibiotic use (OR = 0.68, 95% CI 0.36-1.28). Dexamethasone was associated with fewer episodes of hearing impairment in high quality RCTs (OR = 0.64, 95% CI 0.43-0.94). The currently available evidence suggests that dexamethasone should be administered to all adult patients with bacterial meningitis. Large studies are needed to clarify the role of the duration of symptoms, disease severity, and antibiotic administration before the initiation of treatment with dexamethasone on modifying the outcomes.

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“…An inverse correlation between plasma levels of HIV RNA and serum opsonic activity against type 3 and type 9 strains of S. pneumoniae has been detected in asymptomatic HIV-infected persons [19]. Invasive pneumococcal diseases (IPD) have been a commonly reported, severe complication among HIV-1 infected patients [20, 21]. In HIV-infected children, IPD was noted in the era prior to effective antiretroviral therapy to occur with nearly a three times higher incidence than among HIV-negative children, leading to poorer outcomes and a higher mortality rate [22-24].…”

Section: Introductionmentioning

confidence: 99%

Humoral immune responses to Streptococcus pneumoniae in the setting of HIV-1 infection

Zhang

Wan

et al. 2015

Vaccine

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Streptococcus pneumonia (pneumococcus) remains one of the most commonly identified causes of bacterial infection in the general population, and the risk is 30-100 fold higher in HIV-infected individuals. Both innate and adaptive host immune responses to pneumococcal infection are important against pathogen invasion. Pneumococcal-specific IgA antibody (Ab) is key to control infection at the mucosal sites. Ab responses against pneumococcal infection by B cells can be generated through T cell-dependent or T cell-independent pathways. Depletion of CD4+ T cells is a hallmark of immunodeficiency in HIV infection and this defect also contributes to B cell dysfunction, which predisposes to infections such as the pneumococcus. Two pneumococcal vaccines have been demonstrated to have potential benefits for HIV-infected patients. One is a T cell dependent 13-valent pneumococcal conjugate vaccine (PCV13); the other is a T cell independent 23-valent pneumococcal polysaccharide vaccine (PPV23). However, many questions remain unknown regarding these two vaccines in the clinical setting in HIV disease. Here we review the latest research regarding B cell immune responses against pneumococcal antigens, whether derived from potentially invading pathogens or vaccinations, in the setting of HIV-1 infection.

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Favorable Prognosis of Purulent Meningitis in Patients Infected with Human Immunodeficiency Virus

Cited by 29 publications

References 23 publications

Bacterial Meningitis in Malawian Adults: Pneumococcal Disease is Common, Severe, and Seasonal

Bacterial Meningitis in Malawian Adults: Pneumococcal Disease is Common, Severe, and Seasonal

Adjunctive dexamethasone therapy for bacterial meningitis in adults: a meta‐analysis of randomized controlled trials

Humoral immune responses to Streptococcus pneumoniae in the setting of HIV-1 infection

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