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The effect of HIV infection on paediatric bacterial meningitis in Blantyre, Malawi
  1. E M Molyneux1,
  2. M Tembo4,
  3. K Kayira4,
  4. L Bwanaisa4,
  5. J Mweneychanya4,
  6. A Njobvu4,
  7. H Forsyth2,
  8. S Rogerson3,
  9. A L Walsh4,
  10. M E Molyneux4
  1. 1Paediatric Department College of Medicine, Box 360, Blantyre, Malawi
  2. 2Community and Audiology Department, Royal Liverpool Children’s Hospital, Liverpool, UK
  3. 3The Royal Women‘s Hospital, Melbourne, Australia
  4. 4Wellcome Research Laboratories and College of Medicine, Box 360, Blantyre, Malawi
  1. Correspondence to:
    Dr E M Molyneux
    Paediatric Department College of Medicine, Box 360, Blantyre, Malawi;


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.

  • meningitis
  • HIV
  • outcome

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