Hiv/aids and tuberculous meningitis: a five year retrospective autopsy study at the korle-bu teaching hospital accra Ghana

Abstract

Background: There is paucity of autopsy data on tuberculous meningitis (TBM), even though it is an -important cause of mortality, especially in HIV infected individuals. The objective of the study was to investigate HIV associated TBM mortality patterns, using a descriptive autopsy study. Materials and methods: A retrospective review was carried out of all autopsy log books and hospital files in our institution for cases of TBM for which autopsies were performed during the period 2005 through 2009. Demographic data, category of death and HIV status were recorded. Data were entered and analyzed using SPSS software (version 18). Results: Of the 719 meningitis deaths in our institution during the study period, 98(14.0%), were tuberculosis related. Of the 98 TBM deaths, 87(88.8%) were confirmed by histology, while 10(10.2%) were by brain smear. Ninety six (98.0%) deaths occurred within the background of pulmonary tuberculosis (PTB); 78(79.6%) occurring within a health facility. Forty four (45.0%) of the TBM deaths had HIV co-infection, compared to 27(4.3%) of the 621 cases of purulent bacterial meningitis (PBM). The mean age of TBM cases with HIV co-infection was 36.8 (SD=10.7), and majority 29(66.0%), were males. Forty two (96.0%), out of the 44 HIV-related TBM deaths occurred in a health facility. Conclusion: One out of every two TBM deaths that occurred in a health facility was HIV related and in young male adults. Autopsy studies could be useful in tracing contacts of both infections, for the initiation of early treatment in positive cases.