Neurological Sequelae of Adult Meningitis in Africa: A Systematic Literature Review

Goldberg, Drew W.; Tenforde, Mark W; Mitchell, Howard E.; Jarvis, Joseph N

doi:10.1093/ofid/ofx246

Cited by 13 publications

(8 citation statements)

References 44 publications

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“…Annual global deaths from CM were estimated at 181,100 ( Figure 1) (1). Globally, CM is responsible for roughly 15% of AIDS-related deaths and is associated with significant longterm disability (6,7).…”

Section: Epidemiologymentioning

confidence: 99%

Emerging concepts in HIV-associated cryptococcal meningitis

Lawrence

Boyer-Chammard

Jarvis

2019

Current Opinion in Infectious Diseases

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Purpose of review: HIV-associated cryptococcal meningitis (CM) remains a significant contributor to AIDS-related mortality despite widened access to antiretroviral therapy. Even in clinical trial settings 10-week mortality is roughly 40%. A number of important clinical trials have either recently concluded or are actively recruiting. Recent findings: Global burden of disease etimates suggest CM causes 181,100 deaths annualy. Screening blood for cryptococcal antigen (CrAg) in HIV-infected individuals with CD4 cell counts <100 cells/µL and pre-emptive antifungal treatment for those with detectable CrAg reduces the incidence of CM and is likely to reduce mortality. CM treatment with conventional 14-day courses of amphotericin are associated with high toxicity and mortality and can be reduced to seven days if given alongside flucytosine. Flucytosine is a significantly superior adjunct to amphotericin treatment compared to fluconazole. In settings without amphotericin B dual oral antifungal combinations of flucytosine and fluconazole offer an effective alternative treatment. A single, high-dose of liposomal amphotericin is effective at reducing fungal burden and is being tested in a phase III trial. Summary: Recently completed and ongoing clinical trials are increasing our understanding of how to optimise induction therapy for CM. Advocacy efforts are needed to broaden access to amphotericin formulations and flucytosine.

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Section: Epidemiologymentioning

confidence: 99%

Emerging concepts in HIV-associated cryptococcal meningitis

Lawrence

Boyer-Chammard

Jarvis

2019

Current Opinion in Infectious Diseases

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“…Lumbar puncture is recommended to be performed in all suspected cases with clinical signs and symptoms of invasive meningococcal disease (IMD) except in patients with prolonged seizures, immunocompromised patients, in the presence of signs of space-occupying lesions and in patients with severe impairment of consciousness and shock. In most cases; cerebrospinal fluid (CSF) reveals high opening pressure, pleocytosis, high protein levels and low glucose levels [28]. Neisseria meningitides should be detected in the CSF or blood by Gram staining, standard culture and/or polymerase chain reaction (PCR) [27, 29, 30].…”

Section: Discussionmentioning

confidence: 99%

Rapid response to meningococcal disease cluster in Foya district, Lofa County, Liberia January to February 2018

Rude¹,

Kortimai²,

Fallah³

et al. 2019

Pan Afr Med J

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Introduction Early detection of disease outbreaks is paramount to averting associated morbidity and mortality. In January 2018, nine cases including four deaths associated with meningococcal disease were reported in three communities of Foya district, Lofa County, Liberia. Due to the porous borders between Lofa County and communities in neighboring Sierra Leone and Guinea, the possibility of epidemic spread of meningococcal disease could not be underestimated. Methods The county incidence management system (IMS) was activated that coordinated the response activities. Daily meetings were conducted to review response activities progress and challenges. The district rapid response team (DRRT) was the frontline responders. The case based investigation form; case line list and contacts list were used for data collection. A data base was established and analysed daily for action. Tablets Ciprofloxacin were given for chemoprophylaxis. Results Sixty-seven percent (67%) of the cases were males and also 67% of the affected age range was 3 to 14 years and attending primary school. The attack rate was 7/1,000 population and case fatality rate was 44.4 % with majority of the deaths occurring within 24-48 hours of symptoms onset. Three of the cases tested positive for Neisseria Meningitidis sero-type W while six cases were Epi-linked. None of the cases had recent meningococcal vaccination and no health-worker infections were registered. Conclusion This cluster of cases of meningococcal disease during the meningitis season in a country that is not traditionally part of the meningitis belt emphasized the need for strengthening surveillance, preparedness and response capacity to meningitis.

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“…However, HIV-associated cryptococcosis mortality remains unacceptably high, and globally, cryptococcal meningitis accounts for 15% of AIDS-related deaths. Cryptococcal infection-related deaths were estimated at 181,100 globally, with 75% (135,900) occurring in sub-Saharan Africa [37][38][39].…”

Section: Cryptococcosismentioning

confidence: 99%