title: Epstein-barr virus coinfection in cerebrospinal fluid is associated with increased mortality in Malawian adults with bacterial meningitis.
abstract: Mortality from adult bacterial meningitis exceeds 50% in sub-Saharan Africa. We postulated that-particularly in individuals infected with human immunodeficiency virus (HIV)-herpes simplex virus, varicella zoster virus, Epstein-Barr virus (EBV), and cytomegalovirus (CMV) in the cerebrospinal fluid (CSF) contribute to poor outcome. CSF from 149 Malawian adults with bacterial meningitis and 39 controls were analyzed using polymerase chain reaction. EBV was detected in 79 of 149 bacterial meningitis patients. Mortality (54%) was associated with higher CSF EBV load when adjusted for HIV (P = .01). CMV was detected in 11 of 115 HIV-infected patients, 8 of whom died. The mechanisms by which EBV and CMV contribute to poor outcome require further investigation.
authors.affiliation: Wellcome Trust Tropical Centre, University of Liverpool, Liverpool, United Kingdom. matthew.kelly@liverpool.co.uk
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kelly
authors.forename: Laura A
authors.initials: LA
authors.lastname: Benjamin
authors.forename: Katharine
authors.initials: K
authors.lastname: Cartwright
authors.forename: Katherine M B
authors.initials: KM
authors.lastname: Ajdukiewicz
authors.forename: Danielle B
authors.initials: DB
authors.lastname: Cohen
authors.forename: Mavis
authors.initials: M
authors.lastname: Menyere
authors.forename: Sareen
authors.initials: S
authors.lastname: Galbraith
authors.forename: Malcolm
authors.initials: M
authors.lastname: Guiver
authors.forename: Florian
authors.initials: F
authors.lastname: Neuhann
authors.forename: Tom
authors.initials: T
authors.lastname: Solomon
authors.forename: David G
authors.initials: DG
authors.lastname: Lalloo
authors.forename: Robert S
authors.initials: RS
authors.lastname: Heyderman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D060085:Coinfection / Q000134:cerebrospinal fluid / Q000150:complications / Q000453:epidemiology / Q000401:mortality*; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000134:cerebrospinal fluid / Q000150:complications*; D004279:DNA, Viral / Q000134:cerebrospinal fluid; D020031:Epstein-Barr Virus Infections / Q000134:cerebrospinal fluid / Q000150:complications*; D005260:Female; D015658:HIV Infections / Q000134:cerebrospinal fluid / Q000150:complications / Q000453:epidemiology; D018259:Herpesvirus 1, Human / Q000235:genetics / Q000302:isolation & purification; D018258:Herpesvirus 2, Human / Q000235:genetics / Q000302:isolation & purification; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000302:isolation & purification; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D016015:Logistic Models; D008295:Malawi; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000150:complications / Q000401:mortality*; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D015995:Prevalence; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D004279:DNA, Viral
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