Generic placeholder image

Current HIV Research


ISSN (Print): 1570-162X
ISSN (Online): 1873-4251

Research Article

Spatio-temporal Distribution of Meningitis in HIV Patients in Northern Egypt (2000-2018)

Author(s): Ekram W. Abd El-Wahab*, Yamen Hegazy, Talaat Farrag and Mohammed Metwally

Volume 18, Issue 6, 2020

Page: [405 - 414] Pages: 10

DOI: 10.2174/1570162X18666200810132605

Price: $65


Background: Meningitis is a leading cause of death among patients living with HIV. There is no adequate tracking of the disease occurrence, distribution and etiologic agents among this risk group in Egypt, although the pattern could differ from that of the general population.

Objectives: We aimed to describe the spatio-temporal distribution of meningitis in HIV patients in a region of Northern Egypt over 18 years (2000-2018).

Methods: We conducted a retrospective study of 352 adult HIV patients admitted to a tertiary care fever hospital with neurological manifestations suggesting meningitis. We retrieved from inpatient records all data relevant to patient demographics, clinical presentation, diagnostic work-up, results of laboratory investigations (CSF, blood, imaging), definitive diagnosis, and in-hospital mortality.

Results: The overall trend of over 2 decades showed fluctuating incidence of meningitis in HIV infected patients and increasing spread into rural areas, with a uniform circulation among adult males. Cryptococcal meningitis was the most common etiologic agent (26.9%) and was associated with worse outcomes. Focal neurological deficit (38.5%), cranial nerve involvement (48.1%) were common features in TB Meningitis. The mortality was high (56.8%) and was significantly associated with low CD4+ count, advanced AIDs clinical stage and the presence of co-morbidities.

Conclusion: Despite the availability of cART, meningitis, particularly cryptococcal, is common in HIV/AIDS population in Egypt. Continued efforts are desperately needed to improve the outcomes of HIV-infected patients.

Keywords: Spatial distribution, temporal distribution, meningitis, HIV, AIDS, IRIS.

Graphical Abstract
Veltman JA, Bristow CC, Klausner JD. Meningitis in HIV-positive patients in sub-Saharan Africa: A review. J Int AIDS Soc 2014; 17: 19184.
Britz E, Perovic O, von Mollendorf C, et al. The epidemiology of meningitis among adults in a South African province with a high HIV prevalence, 2009-2012. PLoS One 2016; 11(9)e0163036
Collaborators GBDM. Global, regional, and national burden of meningitis, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2018; 17(12): 1061-82.
Shelburne SA III, Hamill RJ, Rodriguez-Barradas MC, et al. Immune reconstitution inflammatory syndrome: Emergence of a unique syndrome during highly active antiretroviral therapy. Medicine (Baltimore) 2002; 81(3): 213-27.
Agmon-Levin N, Elbirt D, Sthoeger ZM. Immune reconstitution inflammatory syndrome in human immunodeficiency (HIV) infected patients. Harefuah 2008; 147(5): 439-.
Achenbach CJ, Harrington RD, Dhanireddy S, Crane HM, Casper C, Kitahata MM. Paradoxical immune reconstitution inflammatory syndrome in HIV-infected patients treated with combination antiretroviral therapy after AIDS-defining opportunistic infection. Clin Infect Dis 2012; 54(3): 424-33.
Abd El-Wahab EW, Farrag T, Metwally M. A clinical rule for the prediction of meningitis in HIV patients in the era of combination antiretroviral therapy. Trans R Soc Trop Med Hyg 2020; 114(4): 264-75.
National AIDs Program. National HIV/AIDS clinical care guildlines Cairo: Ministry of Health and Poulation . 2015.
Boutros S, Skordis J. HIV/AIDS surveillance in Egypt: current status and future challenges. East Mediterr Health J 2010; 16(3): 251-8.
UNAIDS. Country fact sheet: Egypt 2017 . 2018.
WHO. Eastern Mediterranian HIV program facts sheet. 2018.
Kabapy AF, Shatat HZ, Abd El-Wahab EW. Attributes of HIV infection over decades (1982-2018): A systematic review and meta- analysis. Transbound Emerg Dis 2020.
Boaz MM, Kalluvya S, Downs JA, Mpondo BCT, Mshana SE. Pattern, clinical characteristics, and outcome of meningitis among HIV-infected adults admitted in a tertiary hospital in north western Tanzania: A cross-sectional study. J Trop Med 2016; 20166573672
Almeida SM, Zavala JA, Gabardo BM, Ribeiro CE, Rossoni AM, Araújo JM. Acute bacterial meningitis in HIV, patients in southern Brazil: Curitiba, Paraná, Brazil. Arq Neuropsiquiatr 2007; 65(2A): 273-8.
Vigil KJ, Salazar L, Hasbun R. Community-acquired meningitis in HIV-infected patients in the United States. AIDS Patient Care STDS 2018; 32(2): 42-7.
Chhin S, Rozycki G, Pugatch D, Harwell JI. Aetiology of meningitis in HIV-infected patients in a referral hospital in Phnom Penh, Cambodia. Int J STD AIDS 2004; 15(1): 48-50.
Rajasingham R, Rhein J, Klammer K, et al. Epidemiology of meningitis in an HIV-infected Ugandan cohort. Am J Trop Med Hyg 2015; 92(2): 274-9.
Tenforde MW, Mokomane M, Leeme T, Tlhako N, et al. Epidemiology of adult meningitis during antiretroviral therapy scale-up in southern Africa: Results from the Botswana national meningitis survey. J Infect 2019; 79(3): 212-9.
Mwaba P, Mwansa J, Chintu C, et al. Clinical presentation, natural history, and cumulative death rates of 230 adults with primary cryptococcal meningitis in Zambian AIDS patients treated under local conditions. Postgrad Med J 2001; 77(914): 769-73.
Siddiqi OK, Ghebremichael M, Dang X, et al. Molecular diagnosis of central nervous system opportunistic infections in HIV-infected Zambian adults. Clin Infect Dis 2014; 58(12): 1771-7.
Abhilash KP, Mitra S, Arul JJ, et al. Changing paradigm of cryptococcal meningitis: An eight-year experience from a tertiary hospital in South India. Indian J Med Microbiol 2015; 33(1): 25-9.
Naik KR, Saroja AO, Doshi DK. Hospital-based retrospective study of cryptococcal meningitis in a large cohort from India. Ann Indian Acad Neurol 2017; 20(3): 225-8.
Hoshi T, Fuji Y, Nzou SM, et al. Spatial Distributions of HIV Infection in an Endemic Area of Western Kenya: Guiding Information for Localized HIV Control and Prevention. PLoS One 2016; 11(2)e0148636
Dyson T. HIV/AIDS and Urbanization. Popul Dev Rev 2003; 29(3): 427-42.
Centers of Disease Control and Prevention (CDC). Meningeococcal disease: Age as a risk factor Atlanta: CDC. 2019.
Jarvis JN, Meintjes G, Williams A, Brown Y, Crede T, Harrison TS. Adult meningitis in a setting of high HIV and TB prevalence: Findings from 4961 suspected cases. BMC Infect Dis 2010; 10: 67.
Jarvis JN, Bicanic T, Loyse A, et al. Determinants of mortality in a combined cohort of 501 patients with HIV-associated Cryptococcal meningitis: Implications for improving outcomes. Clin Infect Dis 2014; 58(5): 736-45.
Maziarz EK, Perfect JR. Cryptococcosis. Infect Dis Clin North Am 2016; 30(1): 179-206.
Kanji SS, Kakai R, Onyango RO. Cryptococcal meningitis among human immunodeficiency virus patients attending major hospitals in Kisumu, Western Kenya. Arch Clin Microbiol 2011; 2(1): 1-6.
Nalintya E, Kiggundu R, Meya D. Evolution of cryptococcal antigen testing: What is new? Curr Fungal Infect Rep 2016; 10(2): 62-7.
Currie BP, Freundlich LF, Soto MA, Casadevall A. False-negative cerebrospinal fluid cryptococcal latex agglutination tests for patients with culture-positive cryptococcal meningitis. J Clin Microbiol 1993; 31(9): 2519-22.
Tanner DC, Weinstein MP, Fedorciw B, Joho KL, Thorpe JJ, Reller L. Comparison of commercial kits for detection of cryptococcal antigen. J Clin Microbiol 1994; 32(7): 1680-4.
Ssebambulidde K, Bangdiwala AS, Kwizera R, et al. Adjunctive Sertraline for Treatment of HIV-associated Cryptococcal Meningitis Team. Symptomatic cryptococcal antigenemia presenting as early cryptococcal meningitis with negative cerebral spinal fluid analysis. Clin Infect Dis 2019; 68(12): 2094-8.
Liechty CA, Solberg P, Were W, et al. Asymptomatic serum cryptococcal antigenemia and early mortality during antiretroviral therapy in rural Uganda. Trop Med Int Health 2007; 12(8): 929-35.
Feldmesser M, Harris C, Reichberg S, Khan S, Casadevall A. Serum cryptococcal antigen in patients with AIDS. Clin Infect Dis 1996; 23(4): 827-30.
Saag MS, Graybill RJ, Larsen RA, et al. Infectious Diseases Society of America. Practice guidelines for the management of cryptococcal disease. Clin Infect Dis 2000; 30(4): 710-8.
Rajasingham R, Wake RM, Beyene T, Katende A, Letang E, Boulware DR. Cryptococcal meningitis diagnostics and screening in the era of point-of-care laboratory testing. J Clin Microbiol 2019; 57(1): e01238-18.
Govender N, Meintjes G, Bicanic T, et al. Guideline for the prevention, diagnosis and management of cryptococcal meningitis among HIV-infected persons: 2013 update. South Afr J HIV Med 2013; 14(2): 76-86.
Kabanda T, Siedner MJ, Klausner JD, Muzoora C, Boulware DR. Point-of-care diagnosis and prognostication of cryptococcal meningitis with the cryptococcal antigen lateral flow assay on cerebrospinal fluid. Clin Infect Dis 2014; 58(1): 113-6.
Rugemalila J, Maro VP, Kapanda G, Ndaro AJ, Jarvis JN. Cryptococcal antigen prevalence in HIV-infected Tanzanians: A cross- sectional study and evaluation of a point-of-care lateral flow assay. Trop Med Int Health 2013; 18(9): 1075-9.
Bhigjee AI, Padayachee R, Paruk H, Hallwirth-Pillay KD, Marais S, Connoly C. Diagnosis of tuberculous meningitis: Clinical and laboratory parameters. Int J Infect Dis 2007; 11(4): 348-54.
Cohen DB, Zijlstra EE, Mukaka M, et al. Diagnosis of cryptococcal and tuberculous meningitis in a resource-limited African setting. Trop Med Int Health 2010; 15(8): 910-7.
Hoşoğlu S, Geyik MF, Balik I, et al. Tuberculous meningitis in adults in Turkey: Epidemiology, diagnosis, clinic and laboratory. Eur J Epidemiol 2003; 18(4): 337-43. [corrected].
Pai M, Flores LL, Pai N, Hubbard A, Riley LW, Colford JM Jr. Diagnostic accuracy of nucleic acid amplification tests for tuberculous meningitis: A systematic review and meta-analysis. Lancet Infect Dis 2003; 3(10): 633-43.
Zeka AN, Tasbakan S, Cavusoglu C. Evaluation of the GeneXpert MTB/RIF assay for rapid diagnosis of tuberculosis and detection of rifampin resistance in pulmonary and extrapulmonary specimens. J Clin Microbiol 2011; 49(12): 4138-41.
Juan RS, Sánchez-Suárez C, Rebollo MJ, et al. Interferon gamma quantification in cerebrospinal fluid compared with PCR for the diagnosis of tuberculous meningitis. J Neurol 2006; 253(10): 1323-30.
Belagavi AC, Shalini M. Cerebrospinal fluid C reactive protein and adenosine deaminase in meningitis in adults. J Assoc Physicians India 2011; 59: 557-60.
Patel VB, Theron G, Lenders L, et al. Diagnostic accuracy of quantitative PCR (Xpert MTB/RIF) for tuberculous meningitis in a high burden setting: A prospective study. PLoS Med 2013; 10(10)e1001536
Tuon FF, Higashino HR, Lopes MI, et al. Adenosine deaminase and tuberculous meningitis: A systematic review with meta-analysis. Scand J Infect Dis 2010; 42(3): 198-207.
Xu HB, Jiang RH, Li L, Sha W, Xiao HP. Diagnostic value of adenosine deaminase in cerebrospinal fluid for tuberculous meningitis: A meta-analysis. Int J Tuberc Lung Dis 2010; 14(11): 1382-7.
Hristea A, Olaru ID, Baicus C, Moroti R, Arama V, Ion M. Clinical prediction rule for differentiating tuberculous from viral meningitis. Int J Tuberc Lung Dis 2012; 16(6): 793-8.
Marais S, Thwaites G, Schoeman JF, et al. Tuberculous meningitis: A uniform case definition for use in clinical research. Lancet Infect Dis 2010; 10(11): 803-12.
Wang JT, Hung CC, Sheng WH, Wang JY, Chang SC, Luh KT. Prognosis of tuberculous meningitis in adults in the era of modern antituberculous chemotherapy. J Microbiol Immunol Infect 2002; 35(4): 215-22.
Kalita J, Misra UK, Ranjan P. Predictors of long-term neurological sequelae of tuberculous meningitis: A multivariate analysis. Eur J Neurol 2007; 14(1): 33-7.
Laxminarayan R, Duse A, Wattal C, et al. Antibiotic resistance-the need for global solutions. Lancet Infect Dis 2013; 13(12): 1057-98.
Bhagwan S, Naidoo K. Aetiology, clinical presentation, and outcome of meningitis in patients coinfected with human immunodeficiency virus and tuberculosis. Aids Res Treat 2011.

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy