Aetiology and Outcomes of Suspected Infections of the Central Nervous System in Children in Mbarara, Uganda

Anne-Laure Page,Emmanuel Baron,Said Aberrane,Juliet Mwanga-Amumpaire,Fabienne Nackers,Dan Nyehangane,Céline Langendorf,Deborah Nanjebe,Elizabeth Kemigisha,Rémi Charrel,Nicolas Salez,Yap Boum Ii

doi:10.1038/s41598-017-02741-w

Abstract

Infections of the central nervous system (CNS) are severe conditions, leading to neurological sequelae or death. Knowledge of the causative agents is essential to develop guidelines for case management in resource-limited settings. Between August 2009 and October 2012, we conducted a prospective descriptive study of the aetiology of suspected CNS infections in children two months to 12 years old, with fever and at least one sign of CNS involvement in Mbarara Hospital, Uganda. Children were clinically evaluated on admission and discharge, and followed-up for 6 months for neurological sequelae. Pathogens were identified from cerebrospinal fluid (CSF) and blood using microbiological and molecular methods. We enrolled 459 children. Plasmodium falciparum (36.2%) and bacteria in CSF (13.3%) or blood (3.3%) were the most detected pathogens. Viruses were found in 27 (5.9%) children. No pathogen was isolated in 207 (45.1%) children. Patterns varied by age and HIV status. Eighty-three (18.1%) children died during hospitalisation, and 23 (5.0%) during follow-up. Forty-one (13.5%) children had neurological sequelae at the last visit. While malaria remains the main aetiology in children with suspected CNS infections, no pathogen was isolated in many children. The high mortality and high rate of neurological sequelae highlight the need for efficient diagnosis.

Highlights

Children with a positive HIV serology, reduced consciousness, or respiratory distress on inclusion were more at risk of dying during hospitalisation, while children with non-cerebral malaria were at reduced risk of dying at the hospital compared to other aetiologies (Table 2)
Despite a decrease in malaria prevalence in the area during the study[6], cerebral malaria was the main aetiology in our cohort, followed by bacterial meningitis
We investigated a large range of viruses, we found few viral infections, most of which were in children co-infected with another pathogen

Summary

Introduction

Meningitis was considered if a bacterial pathogen was detected in the CSF by culture, PCR or Gram staining. 61 patients (13.3%) had a bacterial pathogen detected in CSF, either alone (n = 47) or in co-infection (n = 14). S. pneumoniae was the most frequently isolated pathogens in CSF by culture or PCR (n = 34), followed by non-typhoidal Salmonella (NTS, n = 8), and Hib (n = 7) (Table 3).

Results

Conclusion