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Recommend to your librarian. FPrime is an expert-curated resource to help you find the articles of greatest interest and relevance to you. We review the epidemiology, clinical features and treatment in 68 patients with a S.

Central Nervous System Infections

Forty-seven Only 1 death was associated with S. The majority of cases were associated with neurosurgical procedures; however, hematogenous S. PMID: This entry form currently does not support special characters. Disclosures Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality.

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You are a close professional associate of any of the authors e. You work at the same institute as any of the authors. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organization that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors.

I am an author of this article. I am a Faculty Member who recommended this article. Neither of the above. This Agreement shall begin on the date hereof. Certain parts of this website offer the opportunity for users to post opinions, information and material including without limitation academic papers and data 'Material' in areas of the website. The medical care of patients was conducted according to routine local clinical practice and was not influenced by the study. Information on demographics, risk factors, clinical features, and epidemiologic factors were collected on a standardized report form by the study site physicians.

Data on medical history, laboratory tests performed during the care of the patient and treatment rendered was also collected on this form. For study purposes, participants were asked to consent to the collection of an additional 1—3 ml of cerebrospinal fluid CSF beyond the volume normally drawn for examination and diagnosis 3—5 ml.

CSF was preferentially collected prior to antibiotic treatment, consistent with the patient's condition and physician treatment. The level of consciousness was assessed using the Glasgow Coma Scale [15]. In patients with suspected brain hemorrhage or a focal brain lesion, computed tomography CT or magnetic resonance imaging MRI scan was conducted as part of their routine medical assessment.

The CSF laboratory testing panel included cell counts and differential, glucose and protein levels. Based on medical history, clinical presentation, and CSF parameters, clinical suspected diagnoses were made by treating clinicians, and patients were classified into cases with BM, VM, tuberculosis TB meningitis, or viral encephalitis VE [16].

As part of the research study, several laboratory tests were performed for all patients, regardless of clinical diagnoses. MagNA pure automatic extractor, which is a closed system, was used to minimize contamination. The HSC ensured that the extraction was done properly by doing the RNP gene and the water to ensure there was no contamination during extraction. The bacterial real time PCR was singleplex, where each target was done in a separate PCR plate with no primers contamination or mix up.

CNS Infections

The specimens were batched for PCR testing; results were reported back to the treating physicians on a periodic basis, but were not intended to guide clinical management. Confirmatory testing for TB meningitis was not part of this study. Chi-square test was used to compare percentages and the Mann-Whitney U test to compare means. All p-values were two sided and the significance level was set at 0.

The mean age was Thirty-one percent of patients had been hospitalized elsewhere for illnesses related to their CNS illness during the month before presenting to one of the study sites. Patients were symptomatic for a mean duration of 4.

Central nervous system viral disease - Wikipedia

Only one patient remembered receiving HiB vaccine and one patient had received the S. CSF was unavailable on five patients. These and additional CSF parameters are presented in Table 3. Abnormal findings included sinusitis, ethmoidal osteoma, mastoiditis, multiple brain abscesses, and subarachnoid cyst. In four patients, this was the second diagnosis of BM during their lifetime.

There were no differences between clinically diagnosed BM, VM, TB meningitis, and encephalitis by gender, Tbilisi residence, urban residence, animal contact, another illness in the month before patient developed neurologic signs, or hospitalization in the month prior to study enrollment. BM cases had a significantly higher mean age The hospitalization duration was significantly longer among BM and encephalitis cases than among patients diagnosed with VM or TB meningitis. Changes in personality were more likely to occur among BM cases, followed by encephalitis and TB meningitis cases.

Median duration of hospitalization for BM was 22 days range: 3— days ; for VM 9. Five patients with BM presented with petechial rash. In one patient with VZV-associated encephalitis, a papular rash was detected. One year old female diagnosed with encephalitis reported a prior tick bite.

Of 25 cases positive for S. The outcome was unknown in one case of S. Of six cases positive for N. Table 5 shows the distribution of laboratory results within each clinical group. Five S.

The H. In one case, both enterovirus and S. This hospital-based study provides information about the main pathogens causing CNS infections in febrile hospitalized patients in Georgia.

Our data suggest that the most common bacterial pathogen causing meningitis in Georgia is S. The observation that bacterial culture was positive in only five cases 3. These findings highlight the utility of molecular diagnostics for improving pathogen identification for CNS infections. While the use of molecular diagnostic methods substantially enhanced pathogen detection in this study, causative agents were still only detected in half of patients. This low percentage was similar to that reported in other studies [12] , [17] , and is likely a consequence of previous antibiotic use, clearance of virus resulting in absence of detectable nucleic acid, or infection with pathogens not included in the diagnostic panel for our study.

One of the aims of the study was to compare clinical diagnosis with laboratory-based pathogen identification. We noted clear discrepancies between clinical diagnosis and laboratory identification in our study, most notably for VM.


Specifically, ten cases of enterovirus meningitis were erroneously classified as BM which led to unnecessary use of antibiotics. This important finding supports the use of molecular diagnostics in this group of cases, when feasible and affordable, as accurate identification of VM could assist in the targeted use of antibiotics and appropriate allocation of hospital resources. In addition, our study highlights the need for developing a standardized clinical case definition for BM, viral VM, and encephalitis that are evidence-based and correlate to pathologic diagnosis.

Ten months before the study was initiated, a HiB vaccination campaign was initiated in Georgia. However, since very few of our patients reported being vaccinated with HiB vaccine, and we identified only one case of HiB meningitis, we were unable to adequately assess this. Further studies are warranted to discern the long-term impact of HiB and S. The employment of molecular diagnostics for encephalitis is helpful, but still results in a lack of definitive diagnosis in the majority of cases.

This investigation highlights the need for better diagnostic strategies for this syndrome as well as enhanced understanding of non-infectious causes of encephalitis, such as immune-mediated encephalitides, as well as the potential for new, currently unrecognized pathogens as causes of encephalitis. There were several cases of apparent co-infection detected among the study patients. To date, there has not been any reported association between HiB and S. Increase in the use of molecular diagnostics may lead to more frequent detection of co-infection in CNS cases, although it should be noted that a false positive result on one or both of the pathogens detected in our cases based upon our in-house assay cannot be entirely excluded.

Co-infection in CSN patients will be an important topic to assess with further study in larger cohorts and with subsequent validation of results. It is well known that S. Potential explanations of this observation include early and widespread utilization of antibiotics especially antibiotics with good CNS penetration and molecular diagnosis of cases with lower concentrations of bacteria in the CNS.

To test these hypotheses, a comparison of the severity of infection between culture-positive and PCR-positive cases of BM in larger cohort studies is needed. Our study had some limitations. First, the generalizability of our research findings is limited.

Since our study sites represent all of the reference clinics in Georgia except for the National Center for Tuberculosis and Lung Diseases, to which TB meningitis patients are referred , we can make some general assumptions regarding CNS infection in the country; however, extrapolation to other geographic areas outside of the South Caucasus region are probably not possible, given the geographic diversity of pathogens causing CNS infections, worldwide [21].

Second, the number of specific pathogens for laboratory testing was limited and there are other possible etiologies of CNS infection in Georgia e. Lastly, the biological samples associated with the study were limited to CSF, which may be problematic for diagnosis since pathogens may be present in the CNS transiently. For many agents of CNS infections e. In conclusion, this study provides valuable baseline data regarding the frequency and etiology of CNS infections in Georgia, and can serve as a foundation for future assessment of the impact of the introduction of new diagnostic platforms, therapies, and vaccines in Georgia.

Many of our findings substantiate the results of prior investigations regarding pathogens causing CNS infections, and the challenges of arriving at a laboratory-confirmed diagnosis.

The aetiologies of central nervous system infections in hospitalised Cambodian children

However, our study was the first of its kind in the South Caucasus, and further characterized the nature of pathogens causing CNS infections in the region, facilitated by the employment of molecular diagnostics. Observations such as the clinical misclassification of many enteroviral meningitis cases as bacterial infections demonstrate the utility of these assays. Enhanced understanding of the key characteristics of CNS infections in Georgia will assist in public health and health care planning, as interventions strategies are considered and eventually may translate into improved health outcomes in Georgia.

Disclaimer: The opinions and assertions made by the authors do not necessarily reflect the official position or opinion of the Walter Reed Army Institute of Research, the Ministry of Health in Georgia, or any other institution listed. We acknowledge the contribution of all of the participants of the clinical and laboratory network for this study in Georgia, as well as Sebastian-Santiago for his technical assistance.

Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Objectives There is a large spectrum of viral, bacterial, fungal, and prion pathogens that cause central nervous system CNS infections. Methods Children and adults patients clinically diagnosed with meningitis or encephalitis were enrolled at four reference health centers. Results Out of enrolled patients, the mean age was Conclusions Study findings indicate that S.

Introduction Central nervous system CNS infections continue to afflict populations worldwide, especially due to their associations with mortality and long-term disability [1]. Statistical Analysis Chi-square test was used to compare percentages and the Mann-Whitney U test to compare means.

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