Abstract
Central nervous system (CNS) infections are important causes of morbidity and mortality worldwide. In Bolivia, aetiologies, case fatality, and determinants of outcome are poorly characterised. We attempted to investigate such parameters to guide diagnosis, treatment, prevention, and health policy. From Nov-2017 to Oct-2018, we prospectively enrolled 257 inpatients (20.2% HIV-positive patients) of all ages from healthcare centers of Cochabamba and Santa Cruz, Bolivia with a suspected CNS infection and a lumbar puncture performed. Biological diagnosis included classical microbiology, molecular, serological and immunohistochemical tests. An infectious aetiology was confirmed in 128/257 (49.8%) inpatients, including, notably among confirmed single and co-infections, Cryptococcus spp. (41.7%) and Mycobacterium tuberculosis (27.8%) in HIV-positive patients, and Mycobacterium tuberculosis (26.1%) and Streptococcus pneumoniae (18.5%) in HIV-negative patients. The total mortality rate was high (94/223, 42.1%), including six rabies cases. In multivariate logistic regression analysis, mortality was associated with thrombocytopenia (Odds ratio (OR) 5.40, 95%-CI 2.40–11.83) and hydrocephalus (OR 4.07, 95%-CI 1.35–12.23). The proportion of untreated HIV patients, late presentations of neurotuberculosis, the rate of pneumococcal cases, and rabies patients who did not benefit from a post-exposure prophylaxis, suggest that decreasing the burden of CNS infections requires reinforcing health policy regarding tuberculosis, rabies, S. pneumoniae vaccination, and HIV-infections.
Highlights
Central nervous system (CNS) infections are important causes of morbidity and mortality worldwide
Previous limited reports point to the importance of R abies[6], a zoonotic vaccine-preventable viral disease, that remains endemic in B olivia[7] (743 suspected cases of rabies in dogs, 20188); the importance of neurotuberculosis and neurocysticercosis in adults and c hildren[9,10,11] (incidence rate of all types of tuberculosis in Bolivia: 108 (71–154) per 100,000 inhabitants, mortality rate 11 (7.8–14) per 100,000 inhabitants in 2 01812); and other studies indicate that Haemo‐ philus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis are frequently reported as paediatric aetiologies[13,14,15]
An infectious aetiology was confirmed for 49.8% (128/257) of patients, and an autoimmune encephalitis in 1.2% (3/257) of patients
Summary
Central nervous system (CNS) infections are important causes of morbidity and mortality worldwide. The proportion of untreated HIV patients, late presentations of neurotuberculosis, the rate of pneumococcal cases, and rabies patients who did not benefit from a post-exposure prophylaxis, suggest that decreasing the burden of CNS infections requires reinforcing health policy regarding tuberculosis, rabies, S. pneumoniae vaccination, and HIV-infections. Previous limited reports point to the importance of R abies[6], a zoonotic vaccine-preventable viral disease, that remains endemic in B olivia[7] (743 suspected cases of rabies in dogs, 20188); the importance of neurotuberculosis and neurocysticercosis in adults and c hildren[9,10,11] (incidence rate of all types of tuberculosis in Bolivia: 108 (71–154) per 100,000 inhabitants, mortality rate 11 (7.8–14) per 100,000 inhabitants in 2 01812); and other studies indicate that Haemo‐ philus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis are frequently reported as paediatric aetiologies[13,14,15]. Vaccination programs for Haemophilus influenzae and Streptococcus pneumoniae (PCV13) were introduced in 2 00016 and 201417, respectively
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