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Background and Objectives: With increasing access to antiretroviral therapy, HIV-infected youth are living longer, but are vulnerable as they navigate the transition to adulthood while managing a highly stigmatized condition. Knowing one's HIV status is critical to assuming responsibility for one's health. The process of disclosure to adolescents living with HIV is not well understood globally, even less so in China. To help address this gap, we explored practices for disclosure to adolescents living with HIV (ALHIV) among Chinese caregivers and clinicians, and the disclosure experiences of the adolescents themselves using qualitative methods. Design and Setting: The study was conducted in 2014 at the Guangxi Center for Disease Control and Prevention ART (CDC-ART) clinic in Nanning, China. We used a qualitative design, incorporating in-depth interviews (IDIs) and focus group discussions (FGDs). Patients and Methods: We conducted IDIs with 19 adolescent/caregiver dyads and five FGDs with adolescents and clinicians. Adolescent participants were aged 10-15 years, and had contracted HIV perinatally. Using NVivoTM software, we summarized major themes. Results: Only 6/19 caregivers reported disclosing to their child; matched adolescents' statements indicate that 9/19 children knew their HIV status. Caregivers planned to disclose when children were 14 years or older. Concerns about stigma toward children and families were associated with reluctance to disclose. Conclusion: Disclosure to adolescents living with HIV in China was delayed compared with recommended guidelines. Culturally appropriate disclosure strategies should be developed, focused on supporting caregivers and de-stigmatizing HIV.

Background: Anaerobic meningitis is mainly caused by Bacteroides fragilis and it is rarely detected in children. Few cases have been reported and there is usually an underlying cause. The timing of early recognition is crucial because any delay in the diagnosis and initiation of appropriate antimicrobial therapy has a devastating outcome. Only 14 cases have been reported in 50 years. To the best of our knowledge, the present case is the first to be reported in Saudi Arabia with no underlying etiology. Case presentation: We describe a 35-day-old male infant with culture-negative pyogenic meningitis who did not show satisfactory response to the empirical antibiotics, consequently, he developed severe subdural/epidural empyema and ventriculitis. When the drained empyema was cultured anaerobically, B. fragilis was detected and the patient improved after treatment with metronidazole combined with adjuvant surgical drainage of the empyema, and he finally had hydrocephalus. No underlying etiology was found to explain his infection. Conclusion: B. fragilis is an uncommon cause of meningitis that requires a high index of clinical suspicion. Any pyogenic cerebrospinal fluid with negative culture should draw the attention of physicians to an unusual organisms such as anaerobes because early identification and initiation of appropriate antimicrobials can prevent long-term morbidity and mortality.