Tuberculous meningitis is a major cause of mortality and morbidity in adults with central nervous system infections in Kota Kinabalu, Sabah, Malaysia: an observational study.

Heng Gee Lee,Eng Eong Ooi,October Sessions,Timothy William,Anna P Ralph,Tsin Wen Yeo,Yan’An Hou,Jayaram Menon

doi:10.1186/s12879-016-1640-x

Abstract

BackgroundCentral nervous system (CNS) infections are a significant contributor to morbidity and mortality globally. However, most published studies have been conducted in developed countries where the epidemiology and aetiology differ significantly from less developed areas. Additionally, there may be regional differences due to variation in the socio-economic levels, public health services and vaccination policies. Currently, no prospective studies have been conducted in Sabah, East Malaysia to define the epidemiology and aetiology of CNS infections. A better understanding of these is essential for the development of local guidelines for diagnosis and management.MethodsWe conducted a prospective observational cohort study in patients aged 12 years and older with suspected central nervous system infections at Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia between February 2012 and March 2013. Cerebrospinal fluid was sent for microscopy, biochemistry, bacterial and mycobacterial cultures, Mycobacterium tuberculosis polymerase chain reaction (PCR), and multiplex and MassCode PCR for various viral and bacterial pathogens.ResultsA total of 84 patients with clinically suspected meningitis and encephalitis were enrolled. An aetiological agent was confirmed in 37/84 (44 %) of the patients. The most common diagnoses were tuberculous meningitis (TBM) (41/84, 48.8 %) and cryptococcal meningoencephalitis (14/84, 16.6 %). Mycobacterium tuberculosis was confirmed in 13/41 (31.7 %) clinically diagnosed TBM patients by cerebrospinal fluid PCR or culture. The acute case fatality rate during hospital admission was 16/84 (19 %) in all patients, 4/43 (9 %) in non-TBM, and 12/41 (29 %) in TBM patients respectively (p = 0.02).ConclusionTBM is the most common cause of CNS infection in patients aged 12 years or older in Kota Kinabalu, Sabah, Malaysia and is associated with high mortality and morbidity. Further studies are required to improve the management and outcome of TBM.

Highlights

Central nervous system (CNS) infections are a significant contributor to morbidity and mortality globally
In Vietnam, viral encephalitis and meningitis accounted for 34 % of adult CNS infections, with dengue (11 %), enteroviruses (10 %) and herpes simplex (11 %) being the most commonly identified pathogens, while tuberculous meningitis (TBM) accounted for 14 % of cases [5]
Streptococcus pneumoniae and Neisseria meningitides are the most common pathogens of bacterial meningitis in developed countries, Streptococcus suis, a zoonotic pathogens from pigs, is the most common cause in Vietnam [4, 5]. These data suggest that local data are required to develop clinically relevant guidelines In Malaysia, only confirmed cases of viral encephalitis are notifiable while meningitis is not, requiring prospective studies to detail the epidemiology of CNS infections

Summary

Introduction

Central nervous system (CNS) infections are a significant contributor to morbidity and mortality globally. In an encephalitis study in England, infections (42 %) were the leading aetiology, followed by undetermined (37 %) and immune-mediated causes (21 %) [3] Among those with infectious encephalitis, herpes simplex virus (19 %), varicella zoster virus (5 %) and Mycobacterium tuberculosis (MTB) (5 %) were the most common diagnoses [3]. Streptococcus pneumoniae and Neisseria meningitides are the most common pathogens of bacterial meningitis in developed countries, Streptococcus suis, a zoonotic pathogens from pigs, is the most common cause in Vietnam [4, 5]. Taken together, these data suggest that local data are required to develop clinically relevant guidelines

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