The effect of HIV infection on paediatric bacterial meningitis in Blantyre, Malawi.
OBJECTIVE
To compare presentation, progress, and outcome of acute bacterial meningitis in HIV seropositive and seronegative children.


METHODS
A double blind randomised placebo controlled study of the use of dexamethasone as adjuvant therapy in acute bacterial meningitis, in children aged 2 months to 13 years, was carried out from July 1997 to March 2001. A total of 598 children were enrolled, of whom 459 were tested for HIV serostatus.


RESULTS
Of the 459 children, 34% were HIV seropositive. Their presentation was similar to HIV seronegative children but more were shocked on arrival at hospital (33/157 v 12/302), and more had a focus of infection (85/157 v 57/302). HIV positive children had a higher incidence of Streptococcus pneumoniae infections (52% v 32%). Sixty four cases relapsed; 67% were in HIV positive patients. The mortality in HIV positive children was 65% compared with 36% in HIV negative children. The number of survivors in each group was similar. Hearing loss was more common in HIV negative than HIV positive children (66.3% v 47.2%). Steroid therapy had no influence on meningitis in HIV positive children, but the mortality in HIV negative children was 61% in children given steroids, and 39% in those who did not receive steroids.


CONCLUSIONS
HIV seropositive children who develop bacterial meningitis have a high mortality and are prone to recurrent disease. There is an urgent need to prevent both primary and recurrent infections.
Molyneux
E M
EM
Paediatric Department College of Medicine, Box 360, Blantyre, Malawi. emolyneux@malawi.net
Tembo
M
M
Kayira
K
K
Bwanaisa
L
L
Mweneychanya
J
J
Njobvu
A
A
Forsyth
H
H
Rogerson
S
S
Walsh
A L
AL
Molyneux
M E
ME
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000627:therapeutic use; D004311:Double-Blind Method; D024881:Drug Resistance, Bacterial; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007223:Infant; D008295:Malawi; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications* / Q000188:drug therapy; D012008:Recurrence; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D013256:Steroids; D003907:Dexamethasone