ORIGINAL ARTICLE

The effect of HIV infection on paediatric bacterial meningitis in Blantyre, Malawi

E M Molyneux¹, M Tembo⁴, K Kayira⁴, L Bwanaisa⁴, J Mweneychanya⁴, A Njobvu⁴, H Forsyth², S Rogerson³, A L Walsh⁴ and M E Molyneux⁴

¹ Paediatric Department College of Medicine, Box 360, Blantyre, Malawi
² Community and Audiology Department, Royal Liverpool Children’s Hospital, Liverpool, UK
³ The Royal Women‘s Hospital, Melbourne, Australia
⁴ Wellcome Research Laboratories and College of Medicine, Box 360, Blantyre, Malawi

Correspondence to:
Correspondence to:
Dr E M Molyneux
Paediatric Department College of Medicine, Box 360, Blantyre, Malawi; emolyneux{at}malawi.net

Aim: To compare presentation, progress, and outcome of acute bacterial meningitis in HIV seropositive and seronegative children.

Methods: A double blind randomised placebo controlled study of the use of dexamethasone as adjuvant therapy in acute bacterial meningitis, in children aged 2 months to 13 years, was carried out from July 1997 to March 2001. A total of 598 children were enrolled, of whom 459 were tested for HIV serostatus.

Results: Of the 459 children, 34% were HIV seropositive. Their presentation was similar to HIV seronegative children but more were shocked on arrival at hospital (33/157 v 12/302), and more had a focus of infection (85/157 v 57/302). HIV positive children had a higher incidence of Streptococcus pneumoniae infections (52% v 32%). Sixty four cases relapsed; 67% were in HIV positive patients. The mortality in HIV positive children was 65% compared with 36% in HIV negative children. The number of survivors in each group was similar. Hearing loss was more common in HIV negative than HIV positive children (66.3% v 47.2%). Steroid therapy had no influence on meningitis in HIV positive children, but the mortality in HIV negative children was 61% in children given steroids, and 39% in those who did not receive steroids.

Conclusion: HIV seropositive children who develop bacterial meningitis have a high mortality and are prone to recurrent disease. There is an urgent need to prevent both primary and recurrent infections.

Keywords: meningitis; HIV; outcome

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