Spontaneous adult Gram-negative bacillary meningitis in Soweto, South Africa

Abstract

A disproportionate burden of GNB meningitis fell on the HIV-infected, among whom absent or low CSF white cells was common. Management was complicated by high rates of resistance to third-generation cephalosporins.

Clinical and Microbiological Features ofSalmonellaMeningitis in a South African Population, 2003–2013

“…Predisposing conditions in Malawi included HIV infection and malaria [2]. An earlier publication has highlighted NTS as a cause of meningitis in HIV-infected South African adult patients and described the associated characteristics [7], NTS meningitis representing approximately 1.3% of all-cause meningitis in this age group [15]. Previously, we have compared South African and Malawian data, reviewing the role of NTS in invasive disease in these 2 countries.…”

“…Bacterial meningitis in Africa remains an important disease with a high associated mortality [1–7]. Meningitis in human immunodeficiency virus (HIV)–infected persons is frequently associated with cryptococcosis, tuberculosis, and Streptococcus pneumoniae , Haemophilus influenzae type b (Hib), and Neisseria meningitidis [3, 4, 8–12].…”

“…Meningitis in human immunodeficiency virus (HIV)–infected persons is frequently associated with cryptococcosis, tuberculosis, and Streptococcus pneumoniae , Haemophilus influenzae type b (Hib), and Neisseria meningitidis [3, 4, 8–12]. Numerous other pathogens have been described as a cause of meningitis among HIV-infected persons [1, 7, 9, 12, 13]. Nontyphoidal Salmonella (NTS) is emerging as a significant meningeal pathogen among HIV-infected persons, following the decline in incidence of S. pneumoniae and Hib with the introduction of pneumococcal conjugate and Hib conjugate vaccines [1, 6, 9, 12–14].…”

“…Nontyphoidal Salmonella (NTS) is emerging as a significant meningeal pathogen among HIV-infected persons, following the decline in incidence of S. pneumoniae and Hib with the introduction of pneumococcal conjugate and Hib conjugate vaccines [1, 6, 9, 12–14]. In previous series, in adults from South African institutions, NTS meningitis represented 16% of acute bacterial meningitis cases among HIV-infected patients [7]. An estimated 8% of all meningitis cases for which a microbiological diagnosis was made was attributed to acute bacterial meningitis [15].…”

“…Case reports of adults with NTS meningitis frequently describe an association with HIV [7, 18–20], although other immunosuppressive conditions have been described [21–23]. Molyneux et al described NTS meningitis in a cohort of 105 Malawian children, aged between 2 months and 16 years, over a 10-year period [2].…”