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Malawi Medical Journal

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Patient outcome in adults with pneumococcal meningitis or bacteraemia admitted to QECH

SB Gordon

Abstract


Pneumococcal infections are common in Malawian adults. We set out to determine which factors influence in-hospital mortality and long-term survival among these patients. Features of history and examination, inpatient mortality and long-term survival were described among consecutively admitted QECH patients with S. pneumoniae in blood or CSF. 217 patients with pneumococcal disease were studied over an 18-month period. Among these, 158 of 167 consenting to testing (95%) were HIV positive. Inpatient mortality was 65% for pneumococcal meningitis (n=64), 20% for pneumococcaemic pneumonia (n=92) and 26% for patients with pneumococcaemia without localising signs (n=43). Lowered conscious level (OR 5.8, p<0.001), hypotension(OR 4.8, p=0.04) and age exceeding 55 years (OR 3.8, p=0.001) at presentation were associated with inpatient death but not long-term outcome in survivors. Outpatient death was associated with multilobar chest signs (HR 2.1, p=0.01), oral candidiasis (HR 1.8, p=0.03) and severe anaemia (HR 3.9, p=0.005) as an inpatient. In conclusion, most patients with pneumococcal disease in Malawi have severe disease, HIV co-infection and a poor prognosis. At discharge patients with multilobar chest signs or anaemia are at particular risk.


[Malawi Med J, Vol.15(2) 2003: 38-42]



http://dx.doi.org/10.4314/mmj.v15i2.10774
AJOL African Journals Online