The pattern of meningitis in adult Zimbabweans
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Over a six month period a total of sixty five patients (53 male, 12 female) with an average age of 32 years (range 20 - 61) were diagnosed as having meningitis. The commonest type was cryptococcal meningitis (52%) followed by tuberculous meningitis (25%) and pyogenic meningitis (23%). Overall HIV-seroprevalence rate was 82% (cryptococcal 100%, tuberculous 88% and pyogenic 53%) . Most clinical features were not helpful in distinguishing types of meningitis. However there was statistically significant paucity of features of meningism (Neck stiffness and Kernig's sign) in the cryptococcal meningitis group when compared to pyogenic meningitis ( p = 0.009). Cryptococcal meningitis was characterised by lack of an inflammatory response with significantly lower pleocytosis when compared to both pyogenic ( p = 0,00072) and tuberculous meningitis ( p<0,00009). CSF protein was overall lower in the cryptococcal meningitis group. The CSF glucose level was lower in the cryptococcal meningitis group, this being significant when compared to pyogenic meningitis (p<0,024). Clinical features as well as CSF results were similar in HIV-infected and non-HIV-infected patients in both the tuberculous and the pyogenic meningitis groups. The mean CD4 counts were higher in the tuberculous meningitis group compared to both cryptococcal and pyogenic meningitis groups although the difference did not reach statistical significance.