The spectrum of meningitis in a population with high prevalence of HIV disease

We studied the spectrum of meningitis and impact of HIV infectionretrospectively (8 months) and prospectively (5 months) in 284 adultpatients with meningitis hospitalized in Soweto, South Africa. Tuberculousmeningitis (TBM) was the most common cause of meningitis (25.4%) followedby acute bacterial meningitis (ABM; 22.5%), acute viral meningitis (14.1%)and cryptococcal meningitis (13%). The in-hospital mortality was>40% in TBM, ABM, cryptococcal meningitis, the neurosurgery and theparameningeal/parenchymal groups. At least 37.3% of all patients wereHIV-seropositive (only 67% of patients were tested). In at least 27% of thestudy group the meningitis was an AIDS-defining illness (TBM, cryptococcalmeningitis). Only 56.2% of patients with ABM has positive cultures (CSF orblood), of which Streptococcus pneumoniae was by farthe most frequently found organism (35.8%). The spectrum of meningitis inHIV-affected communities in Africa can be expected to change towards apredominance of TBM and cryptococcal meningitis.