Meningitis in HIV‐positive patients in sub‐Saharan Africa: a review

Abstract

IntroductionMeningitis is one of the leading causes of death among patients living with HIV in sub-Saharan Africa. There is no widespread tracking of the incidence rates of causative agents among patients living with HIV, yet the aetiologies of meningitis are different than those of the general population.MethodsWe reviewed the scientific literature published in PubMed to determine the incidence rates of meningitis among hospitalized people living with HIV in sub-Saharan Africa and report our findings from seven studies across sub-Saharan Africa.ResultsWe found high rates of cryptococcal meningitis (19–68%). Tuberculous meningitis was lower (1–36%), although some centres included possible cases as “other” meningitis; therefore, this may not be a true representation of the total cases. Pyogenic meningitis ranged from 6 to 30% and “other” meningitis ranged from 7 to 28% of all reported cases of meningitis. Mortality rates ranged from 25 to 68%. This review describes the most common aetiologies and provides practical diagnostic, treatment and prevention considerations as they apply to the individual living with HIV in sub-Saharan Africa.ConclusionsDiagnosis is often limited, and wider availability of accurate and low-cost laboratory diagnostics is desperately needed for prompt diagnosis and initiation of appropriate treatment. Wider acceptance and adoption of available preventative modalities can decrease the incidence of potentially fatal central nervous system infections in African patients living with HIV.

HIV and new onset seizures: slipping through the cracks in HIV care and treatment

“…In the absence of focal neurological symptoms or signs, a lumbar puncture is generally a safe procedure when performed by a trained clinician, and may be the only way to establish a diagnosis. In the absence of CSF investigation and diagnosis, patients would need to receive empirical medications to cover common infectious pathogens that include bacterial, tuberculous and fungal meningitis in our population [20]. This approach would expose patients to extensive empirical polypharmacy with a substantial risk of drug interactions and toxicities at a huge cost to the public health sector.…”

Is it possible to differentiate tuberculous and cryptococcal meningitis in HIV-infected patients using only clinical and basic cerebrospinal fluid characteristics?

“…More-rare aetiologies include other fungal pathogens (i.e Histoplasma capsulatum , Candida , Coccidiodes ) and viruses (i.e herpes virus, enterovirus). [19,20] …”

Manifestaciones Neurológicas en Pacientes Ambulatorios con Diagnóstico de VIH Atendidos en el Hospital Carlos Andrade Marín.

“…Las bacterias, criptococos y los bacilos de Koch son los principales agentes implicados en la meningitis del paciente con VIH; se pueden manifestar con cefalea, rigidez nucal, confusión, fiebre, crisis convulsivas, alteración del estado mental y en ocasiones focalidad sensitivo-motora [27]. El diagnóstico definitivo se basa en la detección del germen en el líquido cefalorraquídeo (LCR); la toxoplasmosis y el linfoma son las afecciones oportunistas ocupativas de espacio que con más frecuencia se asocian a déficits neurológicos focales [28,29].…”