| dc.description.abstract | This is a clinical and laboratory comparative study of the clinical presentation and outcomes of Meningitis in 75 adult Zambian patients, 44 HIV positive patients ( 28 males and 16 females) and 19 HIV negative( 10 males and 9 females) and 12 (7 males and 5 females) whose serostatus was not known, who were admitted to the University Teaching Hospital with a diagnosis of Meningitis during a period of four months beginning 1st December 1993 ending March 31 1994.The study was prompted by the observation by the researcher of the appearance of a large number of patients who presented with fulminant meningitis associated with severe complications and a high fatality rate in the University Teaching Hospital in the cold season of 1992.
The major objectives of the study were:-
(1)To determine the prevalence clinical and epidemiological features of meningitis in the presence of a Human Immune -deficiency viral infection epidemic.
(2)To establish whether or not there is a significant relationship between meningitis and Human Immunodeficiency Viral Infection
(3)To establish the common organisms causing meningitis in this environment
(4)To determine whether the management of Meningitis should be modified in a patient with HIV infection and
(5)Lastly to determine whether patients who have both meningitis and HIV infection develop more complications and to determine whether or not their outcome is different from that of patients who do not have HIV infection.The Research Hypothesis tested was that "Meningitis has a fulminant presentation associated with greater complications and mortality in patients with HIV infections as compared to those who do not have HIV infection, on the assumption that:-
(a)HIV causes progressive deterioration of the immune system via both qualitative and quantitative dysfunction of CD4 T cells
(b)Autoimmune mechanisms and hyper function
of the immune system associated with HIV infection may be associated with depletion of complement system. All these mechanisms would then predispose patients who have HIV infection to (i) impaired cell mediated immunity (ii) impaired complement system function (iii) recurrent respiratory infections (iv) Bacteremia with encapsulated organisms.All of which are high risk factors for fulminant meningitis, and therefore meningitis in HIV patients would then be expected to be a severe disease with severe complications as compared to meningitis in HIV negative patients.The clinical presentation and outcomes of meningitis in HIV positive patients was compared with that of HIV negative meningitis patients and the following significant findings were noted: 1. Out of 75 patients (45 males 60% and 30 females 40% meningitis patients that participated in the study the serostatus results were received for 63 patients and the distribution was as follows:
44 (28 males and 16 females) were HIV positive and 19 out of 63 were HIV negative giving an over all sero positivity rate of 69% amongst the meningitis patients. The serostatus of 12 patients was not known. 2) The age range was 14 years to 79 with a mean age of 27 years, and 57% of the patients were aged below 40 years.
(3)Meningitis was found to be more prevalent amongst inhabitants of the high density areas i.e. 68 out of the 75 patients came from high population density areas.
(4)Pneumonia was found to proceed meningitis in 12 patients.
(5)The major clinical findings were a history of Headache 100%, fever 80% neckache 80% confusion 13.4% and the commonest physical signs, where neck stiffness in 100% patients, positive Kernigs sign and temperature.
(6)The average duration of symptoms before admission was 2 days. Both groups of patients came to hospital in the early stages of the disease.
(7)However, all those patients who had a history and physical signs of pneumonia on admission did not do well; of the 12 patients who had pneumonia + meningitis
on admission 11 died (92%).
(8)Whereas the initial clinical presentation in the two groups did not differ significantly, the follow up, laboratory findings and outcomes in the two groups was statistically significant.Severe manifestation such as hyperpyrexia 5/8, coma 5/7, seizures, confusional state, bleeding disorders, hemiplegia and 20/30 deaths, occurred more in HIV positive patients than in HIV negative patients, P value < 0.05.
The major causes of meningitis were not identified in that the majority of turbid CSF 50 out of 65 = 77% showed negative cultures. The 15 turbid CSF specimens that showed positive cultures yielded 9 cases Neisseria Meningitides 5 streptococcus pneumonia and 1 Salmonella species. 14 out of 65 (20%) were positive for cryptococcus neoformans and all the 14 occurred in HIV positive patients.The mortality in HIV positive patients was much higher in that 26 out of the 30 deaths (86%) were HIV positive. The proportion of deaths in HIV positive patients was 26/44 = 59%.
All the above strongly supported the hypothesis that stated that meningitis in HIV positive patients is a severe disease associated with a significant number of complications and mortality than in HIV negative patients | en_US |
