ArticlePloS one2013
High mortality amongst adolescents and adults with bacterial meningitis in sub-Saharan Africa: an analysis of 715 cases from Malawi.
Article in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 2 of them syntheses that pooled it.
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Who cites it
34 citing papers in PubMed, 2 syntheses or guidelines pooled it, 58 citations in OpenAlex.
- Global Case Fatality of Bacterial Meningitis During an 80-Year Period: A Systematic Review and Meta-Analysis.JAMA network open · 2024Pooled it
- Non-corticosteroid adjuvant therapies for acute bacterial meningitis.The Cochrane database of systematic reviews · 2021Pooled it
- Epidemiology, clinical outcomes, and factors associated with mortality among cerebrospinal meningitis cases in the Upper West Region of Ghana: an eight-year surveillance study.BMC infectious diseases · 2026Article
- Early seizures and heterogeneity of physiologic recovery in heat-related illness: a nationwide registry study.Critical care (London, England) · 2026Article
- Relapsing Salmonella Meningitis in an Infant: A Case Report and Review of the Literature.Case reports in pediatrics · 2026Article
- Molecular Diagnosis of Bacterial Meningitis in Ethiopia: A Narrative Review of Current Evidence and Implementation Gaps.The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale · 2026Review
- Time to Death and Its Predictors among Children with Bacterial Meningitis in Southwest Ethiopia, 2022. A Retrospective follow-up study.Rwanda journal of medicine and health sciences · 2025Article
- Recurrent spontaneousJAC-antimicrobial resistance · 2023Article
- A qualitative study of factors resulting in care delays for adults with meningitis in Zambia.Transactions of the Royal Society of Tropical Medicine and Hygiene · 2022Article
- Treatment outcome and associated factors of bacterial meningitis at pediatric wards of southwestern Ethiopian hospital: a prospective observational study.Journal of pharmaceutical health care and sciences · 2021Article
- Bacterial genome-wide association study of hyper-virulent pneumococcal serotype 1 identifies genetic variation associated with neurotropism.Communications biology · 2020Article
- Influenza-like illness is associated with high pneumococcal carriage density in Malawian children.The Journal of infection · 2020Article
- Antimicrobial sensitivity profile and bacterial isolates among suspected pyogenic meningitis patients attending at Hawassa University Hospital: Cross-sectional study.BMC microbiology · 2020Article
- Complement factor H contributes to mortality in humans and mice with bacterial meningitis.Journal of neuroinflammation · 2019Article
- HIV infection drives IgM and IgG3 subclass bias in Plasmodium falciparum-specific and total immunoglobulin concentration in Western Kenya.Malaria journal · 2019Article
- Mortality in adult patients with culture-positive and culture-negative meningitis in the Botswana national meningitis survey: a prevalent cohort study.The Lancet. Infectious diseases · 2019Article
- Neurological disorders in HIV in Africa: a review.African health sciences · 2019Review
- Neurological disorders in a consultant hospital in Northern Tanzania. A cohort study.eNeurologicalSci · 2019Article
- Rapid response to meningococcal disease cluster in Foya district, Lofa County, Liberia January to February 2018.The Pan African medical journal · 2019Article
- Neurological Sequelae of Adult Meningitis in Africa: A Systematic Literature Review.Open forum infectious diseases · 2018Review
Corrections and comments
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Authors and funding
12 authors at 5 institutions in 2 countries.
Funding
Abstract
unlabelledMortality from bacterial meningitis in African adults is significantly higher than those in better resourced settings and adjunctive therapeutic interventions such as dexamethasone and glycerol have been shown to be ineffective. We conducted a study analysing data from clinical trials of bacterial meningitis in Blantyre, Malawi to investigate the clinical parameters associated with this high mortality.
methodsWe searched for all clinical trials undertaken in Blantyre investigating bacterial meningitis from 1990 to the current time and combined the data from all included trial datasets into one database. We used logistic regression to relate individual clinical parameters to mortality. Adults with community acquired bacterial meningitis were included if the CSF culture isolate was consistent with meningitis or if the CSF white cell count was >100 cells/mm(3) (>50% neutrophils) in HIV negative participants and >5 cells/mm(3) in HIV positive participants. Outcome was measured by mortality at discharge from hospital (after 10 days of antibiotic therapy) and community follow up (day 40).
resultsSeven hundred and fifteen episodes of bacterial meningitis were evaluated. The mortality rate was 45% at day 10 and 54% at day 40. The most common pathogens were S.pneumoniae (84% of positive CSF isolates) and N.meningitidis (4%). 607/694 (87%) participants tested were HIV antibody positive. Treatment delays within the hospital system were marked. The median presenting GCS was 12/15, 17% had GCS<8 and 44.9% had a seizure during the illness. Coma, seizures, tachycardia and anaemia were all significantly associated with mortality on multivariate analysis. HIV status and pneumococcal culture positivity in the CSF were not associated with mortality. Adults with community acquired bacterial meningitis in Malawi present with a severe clinical phenotype. Predictors of high mortality are different to those seen in Western settings. Optimising in-hospital care and minimising treatment delays presents an opportunity to improve outcomes considerably.
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