Document 2887
 DOCN  M94A2887
 TI    A survey of adult meningitis in Zimbabwe.
 DT    9412
 AU    Malin A; Bwakura T; Robertson V; Musvaire P; University of Zimbabwe
       Medical School, Harare.
 SO    Int Conf AIDS. 1994 Aug 7-12;10(1):202 (abstract no. PB0236). Unique
       Identifier : AIDSLINE ICA10/94369688
 AB    OBJECTIVE: (1) To survey all types of adult meningitis. (2) To identify
       clinical and laboratory markers which distinguish types of meningitis as
       an aid to diagnosis in developing countries. METHODS: Blood, CSF
       (cerebrospinal fluid) and clinical data were collected prospectively
       from unselected, consecutive adults admitted to a central hospital in
       Zimbabwe over a 6 month period. Standard microbiology, biochemistry, HIV
       testing, CD4 phenotyping, and antigen testing (Cryptococcus neoformans,
       Pneumococcus, Meningococcus and H influenzae) were performed. RESULTS:
       Meningitis was demonstrated in 65 cases; 82% were HIV-positive and 80%
       were male. Cases were divided as follows: C neoformans 52%, Pneumococcus
       23% and M tuberculosis (TB) 25%. HIV positivity rates were 100%, 53% and
       88% respectively. Mean CD4 counts in HIV positive cases were 144
       microliters, 116 microliters and 275 microliters respectively.
       Distinguishing characteristics included: (1) a CSF pleocytosis,
       invariable in all cases of TB and Pneumococcus, but absent in 44% of
       cryptococcal cases (p < 0.002), (2) neck stiffness, absent in 26% of
       cryptococcal, 6% of TB and 0% of pneumococcal cases (p < 0.003), and (3)
       confusion, rare in pneumococcal cases (7%) but common with cryptococcal
       cases (44%) and TB cases (56%) (p < 0.006). CONCLUSIONS: Adult
       meningitis was strongly associated with HIV infection. The pathogens
       identified reflect those seen in African AIDS. Signs of meningism, CSF
       inflammatory changes and India Ink staining were often absent in
       cryptococcal meningitis and clinical features were limited to fever and
       headache. An algorithmic approach to management with simple tests is
       possible but antigen testing would greatly assist diagnosis in equivocal
       cases.
 DE    Adult  Biological Markers/BLOOD/CEREBROSPINAL FLUID  Cerebrospinal
       Fluid/CYTOLOGY  Comorbidity  Dyes  Female  Human  HIV
       Infections/EPIDEMIOLOGY  Male  Meningitis/BLOOD/CEREBROSPINAL
       FLUID/COMPLICATIONS/DIAGNOSIS/  *EPIDEMIOLOGY  Meningitis,
       Cryptococcal/EPIDEMIOLOGY  Meningitis, Pneumococcal/EPIDEMIOLOGY  Stains
       and Staining  Tuberculosis, Meningeal/EPIDEMIOLOGY
       Zimbabwe/EPIDEMIOLOGY  MEETING ABSTRACT

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).