Genomic pneumococcal load and CSF cytokines are not related to outcome in Malawian adults with meningitis

Article English OPEN
Wall, E. C. ; Gritzfeld, J. F. ; Scarborough, M. ; Ajdukiewicz, K. M. B. ; Mukaka, M. ; Corless, C. ; Lalloo, D. G. ; Gordon, S. B. (2014)
  • Publisher: W.B. Saunders
  • Journal: The Journal of Infection (issn: 0163-4453, vol: 69, pp: 440-446)
  • Related identifiers: doi: 10.1016/j.jinf.2014.06.011, pmc: PMC4209731
  • Subject: Africa | qu_460 | Bacterial load | Cytokine response | Infectious Diseases | wa_395 | wc_217 | Bacterial meningitis; Streptococcus pneumoniae; Bacterial load; Cerebrospinal fluid; Cytokine response; Mortality; Africa | Article | wc_245 | qw_568 | Cerebrospinal fluid | Mortality | Bacterial meningitis | Microbiology (medical) | Streptococcus pneumoniae

Objective\ud \ud Bacterial meningitis in sub-Saharan Africa is predominantly caused by Streptococcus pneumoniae, is often associated with HIV co-infection and mortality rates are double those seen in better resourced settings.\ud \ud Methods\ud \ud To investigate the cause of this excessive mortality we quantified the pneumococcal DNA load and six common pro-inflammatory cytokines in the cerebrospinal fluid (CSF) of Malawian adults with culture proven pneumococcal meningitis and correlated the results to clinical parameters and outcome. There are currently no published data relating bacterial load to outcome in adults with pneumococcal meningitis.\ud \ud Results\ud \ud The mean age of patients was 32 years, 82% were HIV infected and 49% had died by day 40. CSF bacterial loads were high (median 6.5 × 105 copies/ml CSF) and there was no significant variation in bacterial load between survivors and non-survivors. All pro-inflammatory CSF cytokines were elevated in the CSF, with no clinically important differences between survivors and non-survivors. HIV status did not affect the CSF bacterial load or cytokine response.\ud \ud Conclusion\ud \ud Mortality from pneumococcal meningitis in adults in sub-Saharan Africa is not related to pneumococcal bacterial load. More research is needed to understand the very high mortality from meningitis in this region.
  • References (27)
    27 references, page 1 of 3

    1. Tsai CJ, Griffin MR, Nuorti JP, Grijalva CG. Changing epidemiology of pneumococcal meningitis after the introduction of pneumococcal conjugate vaccine in the United States. Clin Infect Dis Official Publ Infect Dis Soc Am 2008;46(11): 1664e72 [Epub 2008/04/25].

    2. Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev 2010;23(3):467e92 [Epub 2010/07/09].

    3. Wall EC, Everett DB, Mukaka M, Bar-Zeev N, Feasey N, Jahn A, et al. Bacterial meningitis in Malawian adults, adolescents, and children during the era of antiretroviral scale-up and haemophilus influenzae type b vaccination, 2000e2012. Clin Infect Dis Official Publ Infect Dis Soc Am 2014 May;58(10): e137e145. http://dx.doi.org/10.1093/cid/ciu057.

    4. van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004;351(18):1849e59 [Epub 2004/10/29].

    5. Wall E, Carwright K, Scarborough M, Ajdukiewicz K, Goodson P, Mwambene J, et al. High mortality amongst adolescents and adults with bacterial meningitis in sub-Saharan Africa: an analysis of 715 cases from Malawi. PLoS One 2013 Jul 19;8(7): e69783. http://dx.doi.org/10.1371/journal.pone.0069783.

    6. Carrol ED, Guiver M, Nkhoma S, Mankhambo LA, Marsh J, Balmer P, et al. High pneumococcal DNA loads are associated with mortality in Malawian children with invasive pneumococcal disease. Pediatr Infect Dis J 2007;26(5):416e22 [Epub 2007/05/01].

    7. Roine I, Saukkoriipi A, Leinonen M, Peltola H. Microbial genome count in cerebrospinal fluid compared with clinical characteristics in pneumococcal and haemophilus influenzae type b meningitis in children. Diagn Microbiol Infect Dis 2009;63(1): 16e23 [Epub 2008/11/08].

    8. Rello J, Lisboa T, Lujan M, Gallego M, Kee C, Kay I, et al. Severity of pneumococcal pneumonia associated with genomic bacterial load. Chest 2009;136(3):832e40 [Epub 2009/05/13].

    9. Vazquez JA, Adducci Mdel C, Coll C, Godoy Monzon D, Iserson KV. Acute meningitis prognosis using cerebrospinal fluid interleukin6 levels. J Emerg Med 2012;43(2):322e7 [Epub 2011/12/07].

    10. Bociaga-Jasik M, Garlicki A, Ciesla A, Kalinowska-Nowak A, Sobczyk-Krupiarz I, Mach T. The diagnostic value of cytokine and nitric oxide concentrations in cerebrospinal fluid for the differential diagnosis of meningitis. Adv Med Sci 2012;57(1): 142e7 [Epub 2012/04/05].

  • Related Research Results (1)
  • Metrics
    No metrics available