{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T18:54:39Z","timestamp":1791140079377,"version":"4.1.0"},"reference-count":61,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2022,5,11]],"date-time":"2022-05-11T00:00:00Z","timestamp":1652227200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Meningitis remains an important cause of morbi-mortality in adults in sub-Saharan Africa. Data on the etiological investigation of meningitis in adults in Mozambique is limited and most studies were conducted in southern Mozambique. Identification of the etiology of meningitis in adults are crucial to guide prevention and treatments strategies. In this study, we determine the burden of fungal and bacterial meningitis among adults at the three largest hospitals in Mozambique.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Method<\/jats:title>\n<jats:p>We performed analysis of data from the routine sentinel surveillance system for meningitis in Mozambique from January 2016 to December 2017. Cerebrospinal fluid (CSF) samples were collected from eligible adults (\u226518 years old) who met World Health Organization (WHO) case definition criteria for Meningitis. All samples were tested by cryptococcal antigen (CrAg) lateral flow assay (LFA), culture and triplex real-time polymerase chain reaction (qPCR) assay and all patients were tested for human immunodeficiency virus (HIV) using the national algorithm for HIV testing.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Retrospective analysis of 1501 CSF samples from adults clinically suspected of meningitis revealed that 10.5% (158\/1501) were positive for bacterial and fungal meningitis. Of these 158 confirmed cases, the proportion of Cryptococcal meningitis and pneumococcal meningitis was38.6% (95% CI: 31.0% to 46.7%) and 36.7% (95% CI: 29.2% to 44.7%), respectively. The other bacterial agents of meningitis identified include <jats:italic>Neisseria meningitidis<\/jats:italic> (8.9%; 14\/158), <jats:italic>Escherichia coli<\/jats:italic> (6.3%; 10\/158), <jats:italic>Haemophilus influenzae<\/jats:italic> (5.1%; 8\/158) and <jats:italic>S<\/jats:italic>. <jats:italic>aureus<\/jats:italic> (4.4%; 7\/158), which represent (24.7%; 39\/158) of the total confirmed cases.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Altogether, our findings show a high burden of Cryptococcal meningitis among adults in Mozambique, especially in people living with HIV, followed by pneumococcal meningitis. Our findings suggest that rollout of CrAg Lateral Flow Assay in the health system in Mozambique for early detection of cryptococcus neoformans is necessary to improve overall patient care.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0267949","type":"journal-article","created":{"date-parts":[[2022,5,11]],"date-time":"2022-05-11T18:19:19Z","timestamp":1652293159000},"page":"e0267949","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Etiology of meningitis among adults in three quaternary hospitals in Mozambique, 2016\u20132017: The role of HIV"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1244-0332","authenticated-orcid":true,"given":"Aquino Albino","family":"Nhantumbo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte Elizabeth","family":"Com\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pl\u00e1cida Iliany","family":"Maholela","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alcides Moniz","family":"Munguambe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulino da","family":"Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3459-7277","authenticated-orcid":true,"given":"Mariana","family":"Mott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2580-2494","authenticated-orcid":true,"given":"Gabriella Rosa","family":"Cunha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L\u00facia","family":"Chambal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00edcero","family":"Dias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vlademir Vicente","family":"Cantarelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo Samo","family":"Gudo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,5,11]]},"reference":[{"issue":"8","key":"pone.0267949.ref001","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/S1473-3099(17)30243-8","article-title":"Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis","volume":"17","author":"R Rajasingham","year":"2017","journal-title":"Lancet Infect Dis"},{"issue":"3","key":"pone.0267949.ref002","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1128\/CMR.00070-09","article-title":"Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis","volume":"23","author":"MC Brouwer","year":"2010","journal-title":"Clinical microbiology reviews"},{"issue":"6","key":"pone.0267949.ref003","doi-asserted-by":"crossref","first-page":"e0198772","DOI":"10.1371\/journal.pone.0198772","article-title":"Global etiology of bacterial meningitis: A systematic review and meta-analysis","volume":"13","author":"AM Oordt-Speets","year":"2018","journal-title":"PLoS ONE"},{"key":"pone.0267949.ref004","first-page":"9","article-title":"Review of Meningitis Surveillance Data, Upper West Region, Ghana 2009\u20132013","volume":"25","author":"R.D. 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Defeating Meningitis by 2030: A Global Road Map. 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