title: Spontaneous adult Gram-negative bacillary meningitis in Soweto, South Africa.
abstract: BACKGROUND
  Gram-negative bacillary (GNB) meningitis is a rare cause of meningitis in adults and can occur as a spontaneous infection or as a complication of a neurosurgical procedure or trauma. We aimed to describe the characteristics and outcomes of adults with spontaneous GNB meningitis.
  
  
  METHODS
  A retrospective cohort analysis was performed of 26 patients with GNB meningitis seen at a single hospital in Soweto, South Africa.
  
  
  RESULTS
  A predisposing condition was found in 24 (92%) patients. The 19 (73%) HIV-infected patients had a median CD4 count of 24/mm(3). Chronic renal disease, diabetes mellitus, myeloma, and alcoholism were other underlying conditions. The HIV-infected had a median cerebrospinal fluid (CSF) neutrophil count of 2/mm(3) compared to the HIV-non-infected of 560/mm(3). Common organisms were Escherichia coli, Klebsiella pneumoniae, and non-typhoidal Salmonella in HIV-positive patients and K. pneumoniae in the HIV-negative group. Ten (38%) isolates were resistant to third-generation cephalosporins. Mortality was 65%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Chris Hani Baragwanath Hospital and Faculty of Health Sciences, University of the Witwatersrand, PO Bertsham, 2013 Johannesburg, South Africa.
authors.forename: Gloria
authors.initials: G
authors.lastname: Teckie
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Chris Hani Baragwanath Hospital and Faculty of Health Sciences, University of the Witwatersrand, PO Bertsham, 2013 Johannesburg, South Africa. Electronic address: karstaedt@mweb.co.za.
authors.forename: Alan
authors.initials: A
authors.lastname: Karstaedt
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D060085:Coinfection / Q000175:diagnosis / Q000382:microbiology; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D008875:Middle Aged; D012189:Retrospective Studies; D013019:South Africa; D055815:Young Adult
keywords: Adults; Africa; Gram-negative bacillary meningitis; HIV