Meningitis: Burden, Causes, Screening and Prevention in Rural Northern Uganda

Fogarty International Center of the National Institute of Health, Infectious Disease Institute at Makerere University, Lira University

This study will investigate the burden, causes, diagnostics, treatments and preventive measures related to meningitis in northern Uganda. We hypothesize that understanding the burden of meningitis, risk factors, diagnostics, treatments and the preventive measures will provide information regarding the gaps in care that can be addressed in order to improve the continuum of meningitis care. we hypothesize that our data will support the advocacy for the implementation of routine vaccination for the prevention of bacterial meningitis and improving guidelines for Cryptococcal antigen (CrAg) screening for prevention of cryptococcal meningitis, which will save lives in Uganda. Aim 1: To prospectively collect data on all patients with meningitis and meningitis symptoms who were admitted to Lira Regional Referral Hospital (LRRH) to assess burden, etiologies, pathogenesis, and outcomes of meningitis using modern diagnostic testing not previously available in Uganda. Aim 2: To perform CrAg screening of 10,000 HIV-positive patients to determine the prevalence of cryptococcal antigenemia (infection) and conduct a case control study to compare risk factors and outcomes among CrAg-positive patients and matched CrAg-negative controls based on age, sex, TB status, ART experience, CD4 count, and viral load.

Patients who are assessed at Lira Regional Referral Hospital emergency room or are admitted to the pediatric, male or female medical wards at Lira Regional Referral Hospital with meningitis symptoms (defined as headache or irritability in combination with fever, confusion or Glasgow coma scale (GCS) <14, photophobia, neck pain/stiffness, seizure or bulging fontanel) will be approached to participate in the study.

All HIV-infected patients of any age, who receive care at the Lira Infectious Disease Center will be approached for screening for cryptococcal antigen. Those who test positive using the CrAg test will be included in this arm.

All HIV-infected patients of any age, who receive care at the Lira Infectious Disease Center will be approached for screening for cryptococcal antigen. Those who test negative using the CrAg test will be included in this arm. All HIV-infected patients of any age, who receive care at the Lira Infectious Disease Center will be approached for screening for cryptococcal antigen. Those who test positive using the CrAg test will be included in this arm.

number of participants who were screened using the CrAg diagnostic test who were cryptococcal antigen positive

Inclusion Criteria: All patients who present with meningitis or meningitis symptoms, regardless of age or vulnerably status is eligible for meningitis testing. Approximately 10,000 HIV-infected patients presenting to the LRRH HIV Clinic (LIDC), regardless of age or vulnerability status, are eligible for CrAg screening. Exclusion Criteria: Patients who are found not to have meningitis after initial evaluation, or are found to have other alternative diagnoses that explain their symptoms, will be excluded. CrAg-negative HIV-infected patients who have other active opportunistic infections will be excluded from enrollment in the control group.