{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:07:20Z","timestamp":1785888440149,"version":"3.56.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2019,10,1]],"date-time":"2019-10-01T00:00:00Z","timestamp":1569888000000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"National Institute of Neurologic Diseases and Stroke","award":["R01NS086312"],"award-info":[{"award-number":["R01NS086312"]}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["K01TW010268"],"award-info":[{"award-number":["K01TW010268"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["R25TW009345"],"award-info":[{"award-number":["R25TW009345"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["T32AI055433"],"award-info":[{"award-number":["T32AI055433"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"name":"United Kingdom Medical Research Council\/DfID\/Wellcome Trust Global Clinical Trials","award":["M007413"],"award-info":[{"award-number":["M007413"]}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["210772\/Z\/18\/Z"],"award-info":[{"award-number":["210772\/Z\/18\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Central nervous system (CNS) infections remain a major public health problem in Sub-Saharan Africa, causing 15%\u201325% of AIDS-related deaths. With widespread availability of antiretroviral therapy (ART) and the introduction of improved diagnostics, the epidemiology of infectious meningitis is evolving.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We prospectively enrolled adults presenting with HIV-associated meningitis in Kampala and Mbarara, Uganda, from March 2015 to September 2017. Participants had a structured, stepwise diagnostic algorithm performed of blood cryptococcal antigen (CrAg), CSF CrAg, Xpert MTB\/RIF for tuberculous (TB) meningitis (TBM), Biofire multiplex polymerase chain reaction, and traditional microscopy and cultures.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We screened 842 consecutive adults with HIV presenting with suspected meningitis: 57% men, median age 35 years, median CD4 26 cells\/mcL, and 55% presented on ART. Overall, 60.5% (509\/842) were diagnosed with first-episode cryptococcal meningitis and 7.4% (62\/842) with second episode. Definite\/probable TB meningitis was the primary diagnosis in 6.9% (58\/842); 5.3% (n = 45) had microbiologically confirmed (definite) TB meningitis. An additional 7.8% (66\/842) did not meet the diagnostic threshold for definite\/probable TBM but received empiric TBM therapy. Bacterial and viral meningitis were diagnosed in 1.3% (11\/842) and 0.7% (6\/842), respectively. The adoption of a cost-effective stepwise diagnostic algorithm allowed 79% (661\/842) to have a confirmed microbiological diagnosis at an average cost of $44 per person.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Despite widespread ART availability, Cryptococcus remains the leading cause of HIV-associated meningitis. The second most common etiology was TB meningitis, treated in 14.7% overall. The increased proportion of microbiologically confirmed TBM cases reflects the impact of new improved molecular diagnostics.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofz419","type":"journal-article","created":{"date-parts":[[2019,10,1]],"date-time":"2019-10-01T08:02:32Z","timestamp":1569916952000},"source":"Crossref","is-referenced-by-count":49,"title":["The Changing Epidemiology of HIV-Associated Adult Meningitis, Uganda 2015\u20132017"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7009-9144","authenticated-orcid":false,"given":"Jayne","family":"Ellis","sequence":"first","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"},{"name":"Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ananta S","family":"Bangdiwala","sequence":"additional","affiliation":[{"name":"University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona V","family":"Cresswell","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"},{"name":"Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0480-9646","authenticated-orcid":false,"given":"Joshua","family":"Rhein","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"},{"name":"University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin","family":"Nuwagira","sequence":"additional","affiliation":[{"name":"Mbarara University of Science and Technology, Mbarara, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Ssebambulidde","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lillian","family":"Tugume","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radha","family":"Rajasingham","sequence":"additional","affiliation":[{"name":"University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah C","family":"Bridge","sequence":"additional","affiliation":[{"name":"University of Minnesota, Minneapolis, Minnesota, USA"},{"name":"Mbarara University of Science and Technology, Mbarara, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conrad","family":"Muzoora","sequence":"additional","affiliation":[{"name":"Mbarara University of Science and Technology, Mbarara, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B","family":"Meya","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University, Kampala, Uganda"},{"name":"University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R","family":"Boulware","sequence":"additional","affiliation":[{"name":"University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,9,29]]},"reference":[{"key":"2020081005081514000_CIT0001","doi-asserted-by":"crossref","first-page":"e1001400","DOI":"10.1371\/journal.pmed.1001400","article-title":"Surveillance Programme of IN-patients and Epidemiology (SPINE): implementation of an electronic data collection tool within a large hospital in Malawi","volume":"10","author":"SanJoaquin","year":"2013","journal-title":"PLoS Med"},{"key":"2020081005081514000_CIT0002","volume-title":"World Health Organization. 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