Epidemiology of meningitis in an HIV-infected Ugandan cohort.
There is limited understanding of the epidemiology of meningitis among human immunodeficiency virus (HIV)-infected populations in sub-Saharan Africa. We conducted a prospective cohort study of HIV-infected adults with suspected meningitis in Uganda, to comprehensively evaluate the etiologies of meningitis. Intensive cerebrospiral fluid (CSF) testing was performed to evaluate for bacterial, viral, fungal, and mycobacterial etiologies, including neurosyphilis,16s ribosomal DNA (rDNA) polymerase chain reaction (PCR) for bacteria, Plex-ID broad viral assay, quantitative-PCR for HSV-1/2, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and Toxoplasma gondii; reverse transcription-PCR (RT-PCR) for Enteroviruses and arboviruses, and Xpert MTB/RIF assay. Cryptococcal meningitis accounted for 60% (188 of 314) of all causes of meningitis. Of 117 samples sent for viral PCR, 36% were EBV positive. Among cryptococcal antigen negative patients, the yield of Xpert MTB/RIF assay was 22% (8 of 36). After exclusion of cryptococcosis and bacterial meningitis, 61% (43 of 71) with an abnormal CSF profile had no definitive diagnosis. Exploration of new TB diagnostics and diagnostic algorithms for evaluation of meningitis in resource-limited settings remains needed, and implementation of cryptococcal diagnostics is critical.
University of Minnesota, Minneapolis, Minnesota; Infectious Disease Institute, Makerere University, Kampala, Uganda; Minnesota Department of Health, St. Paul, Minnesota; Centers for Disease Control and Prevention, Fort Collins, Colorado; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda Radha.Rajasingham@gmail.com.
Radha
R
Rajasingham
University of Minnesota, Minneapolis, Minnesota; Infectious Disease Institute, Makerere University, Kampala, Uganda; Minnesota Department of Health, St. Paul, Minnesota; Centers for Disease Control and Prevention, Fort Collins, Colorado; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Joshua
J
Rhein
University of Minnesota, Minneapolis, Minnesota; Infectious Disease Institute, Makerere University, Kampala, Uganda; Minnesota Department of Health, St. Paul, Minnesota; Centers for Disease Control and Prevention, Fort Collins, Colorado; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Kate
K
Klammer
University of Minnesota, Minneapolis, Minnesota; Infectious Disease Institute, Makerere University, Kampala, Uganda; Minnesota Department of Health, St. Paul, Minnesota; Centers for Disease Control and Prevention, Fort Collins, Colorado; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Abdu
A
Musubire
University of Minnesota, Minneapolis, Minnesota; Infectious Disease Institute, Makerere University, Kampala, Uganda; Minnesota Department of Health, St. Paul, Minnesota; Centers for Disease Control and Prevention, Fort Collins, Colorado; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Henry
H
Nabeta
University of Minnesota, Minneapolis, Minnesota; Infectious Disease Institute, Makerere University, Kampala, Uganda; Minnesota Department of Health, St. Paul, Minnesota; Centers for Disease Control and Prevention, Fort Collins, Colorado; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Andrew
A
Akampurira
University of Minnesota, Minneapolis, Minnesota; Infectious Disease Institute, Makerere University, Kampala, Uganda; Minnesota Department of Health, St. Paul, Minnesota; Centers for Disease Control and Prevention, Fort Collins, Colorado; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Eric C
EC
Mossel
University of Minnesota, Minneapolis, Minnesota; Infectious Disease Institute, Makerere University, Kampala, Uganda; Minnesota Department of Health, St. Paul, Minnesota; Centers for Disease Control and Prevention, Fort Collins, Colorado; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Darlisha A
DA
Williams
University of Minnesota, Minneapolis, Minnesota; Infectious Disease Institute, Makerere University, Kampala, Uganda; Minnesota Department of Health, St. Paul, Minnesota; Centers for Disease Control and Prevention, Fort Collins, Colorado; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Dave J
DJ
Boxrud
University of Minnesota, Minneapolis, Minnesota; Infectious Disease Institute, Makerere University, Kampala, Uganda; Minnesota Department of Health, St. Paul, Minnesota; Centers for Disease Control and Prevention, Fort Collins, Colorado; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Mary B
MB
Crabtree
University of Minnesota, Minneapolis, Minnesota; Infectious Disease Institute, Makerere University, Kampala, Uganda; Minnesota Department of Health, St. Paul, Minnesota; Centers for Disease Control and Prevention, Fort Collins, Colorado; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Barry R
BR
Miller
University of Minnesota, Minneapolis, Minnesota; Infectious Disease Institute, Makerere University, Kampala, Uganda; Minnesota Department of Health, St. Paul, Minnesota; Centers for Disease Control and Prevention, Fort Collins, Colorado; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Melissa A
MA
Rolfes
University of Minnesota, Minneapolis, Minnesota; Infectious Disease Institute, Makerere University, Kampala, Uganda; Minnesota Department of Health, St. Paul, Minnesota; Centers for Disease Control and Prevention, Fort Collins, Colorado; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Supatida
S
Tengsupakul
University of Minnesota, Minneapolis, Minnesota; Infectious Disease Institute, Makerere University, Kampala, Uganda; Minnesota Department of Health, St. Paul, Minnesota; Centers for Disease Control and Prevention, Fort Collins, Colorado; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Alfred O
AO
Andama
University of Minnesota, Minneapolis, Minnesota; Infectious Disease Institute, Makerere University, Kampala, Uganda; Minnesota Department of Health, St. Paul, Minnesota; Centers for Disease Control and Prevention, Fort Collins, Colorado; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
David B
DB
Meya
University of Minnesota, Minneapolis, Minnesota; Infectious Disease Institute, Makerere University, Kampala, Uganda; Minnesota Department of Health, St. Paul, Minnesota; Centers for Disease Control and Prevention, Fort Collins, Colorado; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
David R
DR
Boulware
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000328:Adult; D016207:Cytokines / Q000134:cerebrospinal fluid; D005260:Female; D006801:Humans; D008297:Male; D008581:Meningitis / Q000134:cerebrospinal fluid / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D008582:Meningitis, Aseptic / Q000453:epidemiology / Q000209:etiology; D016920:Meningitis, Bacterial / Q000453:epidemiology / Q000209:etiology; D016919:Meningitis, Cryptococcal / Q000453:epidemiology / Q000209:etiology; D008587:Meningitis, Viral / Q000453:epidemiology / Q000209:etiology; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D014390:Tuberculosis, Meningeal / Q000453:epidemiology / Q000209:etiology; D014454:Uganda
D016207:Cytokines