The Epidemiology of Meningitis among Adults in a South African Province with a High HIV Prevalence, 2009-2012.
The Epidemiology of Meningitis among Adults in a South African Province with a High HIV Prevalence, 2009-2012.
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DOI：
10.1371/journal.pone.0163036
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Govender NP
中科院分区：
文献类型：
--
作者：
Britz E;Perovic O;von Mollendorf C;von Gottberg A;Iyaloo S;Quan V;Chetty V;Sriruttan C;Ismail NA;Nanoo A;Musekiwa A;Reddy C;Viljoen K;Cohen C;Govender NP
脑膜炎是南部非洲死亡的主要原因。我们的目的是描述病原学和实验室确认的真菌和细菌性脑膜炎在南非一个省的成人中的频率，艾滋病毒的患病率为11%，超过4年。我们对2009年至2012年提交给豪登省公共部门实验室的所有脑脊液（CSF）标本的二级实验室数据进行了回顾性观察性研究。我们计算了一般人群和HIV感染人群的病因特异性发病率，并使用泊松回归来确定趋势是否显著。我们从110，885份CSF标本中确定了11，891例（10.7%）脑膜炎病例。隐球菌性脑膜炎、结核性脑膜炎和肺炎球菌性脑膜炎分别占四年期间病例的62.3%（n = 7 406）、24.6%（n = 2 928）和10.1%（n = 1 197）。隐球菌脑膜炎的总发病率（每10万人中的病例数）从2009年的24.4例下降到2012年的18.7例（p <0.001），下降了23%，艾滋病毒感染者的发病率从178.2例下降到144.7例（p <0.001）。脑膜炎发病率下降了40%，从2009年的11.3例下降到2012年的6.8例（p <0.001），艾滋病毒感染者的发病率下降了36%，从54.4例下降到34.9例（p <0.001）。肺炎球菌脑膜炎从2009年的4.2例下降到2012年的2.5例（p <0.001），减少了41%，艾滋病毒感染者从28.0例下降到17.5例（p <0.001），减少了38%。在其他细菌性脑膜炎病例（248/11，891，2.1%）中，脑膜炎奈瑟菌（n = 93）、大肠埃希菌（n = 72）和流感嗜血杆菌（n = 20）是最常见的微生物。在这个艾滋病毒高流行省，隐球菌脑膜炎是实验室确认的成人脑膜炎的主要原因。在4年期间，隐球菌性、结核性和肺炎球菌性脑膜炎的发病率显著下降。这与国家抗逆转录病毒治疗方案的扩大、结核病控制方案的加强和肺炎球菌结合疫苗的常规儿童免疫接种相吻合。
Meningitis is a major cause of mortality in southern Africa. We aimed to describe the aetiologies and frequencies of laboratory-confirmed fungal and bacterial meningitis among adults in a South African province with an 11% HIV prevalence, over 4 years. We conducted a retrospective, observational study of secondary laboratory data, extracted on all cerebrospinal fluid (CSF) specimens submitted to public-sector laboratories in Gauteng province from 2009 through 2012. We calculated cause-specific incidence rates in the general and HIV-infected populations and used Poisson regression to determine if trends were significant. We identified 11,891 (10.7%) incident cases of meningitis from 110,885 CSF specimens. Cryptococcal meningitis, tuberculous meningitis and pneumococcal meningitis accounted for 62.3% (n = 7,406), 24.6% (n = 2,928) and 10.1% (n = 1,197) of cases over the four-year period. The overall incidence (cases per 100,000 persons) of cryptococcal meningitis declined by 23% from 24.4 in 2009 to 18.7 in 2012 (p <0.001) and decreased by 19% among HIV-infected persons from 178.2 to 144.7 (p <0.001). Tuberculous meningitis decreased by 40% from 11.3 in 2009 to 6.8 in 2012 (p <0.001) and decreased by 36% among HIV-infected persons from 54.4 to 34.9 (p <0.001). Pneumococcal meningitis decreased by 41% from 4.2 in 2009 to 2.5 in 2012 (p <0.001) and decreased by 38% among HIV-infected persons from 28.0 to 17.5 (p <0.001). Among cases of other bacterial meningitis (248/11,891, 2.1%), Neisseria meningitidis (n = 93), Escherichia coli (n = 72) and Haemophilus influenzae (n = 20) were the most common organisms identified. In this high HIV-prevalence province, cryptococcal meningitis was the leading cause of laboratory-confirmed meningitis among adults. Over a 4-year period, there was a significant decrease in incidence of cryptococcal, tuberculous and pneumococcal meningitis. This coincided with expansion of the national antiretroviral treatment programme, enhanced tuberculosis control programme and routine childhood immunisation with pneumococcal conjugate vaccines.
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影响因子：
3.7
作者：
Jarvis JN;Meintjes G;Williams A;Brown Y;Crede T;Harrison TS
通讯作者：
Harrison TS
影响因子：
3.8
作者：
Cohen, Cheryl;Singh, Elvira;von Gottberg, Anne
通讯作者：
von Gottberg, Anne
影响因子：
3.7
作者：
Marais S;Pepper DJ;Schutz C;Wilkinson RJ;Meintjes G
通讯作者：
Meintjes G
影响因子：
158.5
作者：
Heemskerk, A. Dorothee;Bang, Nguyen D.;Farrar, Jeremy J.
通讯作者：
Farrar, Jeremy J.
影响因子：
34.3
作者：
Churchyard, Gavin J.;Stevens, Wendy S.;Fielding, Katherine L.
通讯作者：
Fielding, Katherine L.