Presentation, etiology, and outcome of brain infections in an Indonesian hospital: A cohort study. Issue 5 (October 2018)

• Record Type: Journal Article
• Authors: Imran, Darma; Estiasari, Riwanti; Maharani, Kartika; Sucipto, ; Lestari, Delly Chipta; Yunus, Reyhan Eddy; Yunihastuti, Evy; Karyadi, Teguh Haryono; Oei, Diana; Timan, Ina S.; Wulandari, Dewi; Wahyuningsih, Retno; Adawiyah, Robiatul; Kurniawan, Agnes; Mulyadi, Rahmad; Karuniawati, Anis; Jaya, Ungke Anton; Safari, Dodi; van Laarhoven, Arjan; Alisjahbana, Bachti; Dian, Sofiati; Chaidir, Lidya; Ganiem, Ahmad Rizal; Lastri, Diatri Nari; Aye Myint, Khin Saw; van Crevel, Reinout
• Is Part Of: Neurology. Volume 8:Issue 5(2018)
• Publication Date: 2018-10
• Subjects: Nervous system -- Diseases -- Periodicals; Neurology -- Periodicals; Neurology -- United States -- Periodicals; 616.8
• DOI: 10.1212/CPJ.0000000000000517
• Languages: English
• ISSNs: 2163-0402

Abstract

Abstract : Background: Little detailed knowledge is available regarding the etiology and outcome of CNS infection, particularly in HIV-infected individuals, in low-resource settings. Methods: From January 2015 to April 2016, we prospectively included all adults with suspected CNS infection in a referral hospital in Jakarta, Indonesia. Systematic screening included HIV testing, CSF examination, and neuroimaging. Results: A total of 274 patients with suspected CNS infection (median age 26 years) presented after a median of 14 days with headache (77%), fever (78%), seizures (27%), or loss of consciousness (71%). HIV coinfection was common (54%), mostly newly diagnosed (30%) and advanced (median CD4 cell count 30/µL). Diagnosis was established in 167 participants (65%), including definite tuberculous meningitis (TBM) (n = 44), probable TBM (n = 48), cerebral toxoplasmosis (n = 48), cryptococcal meningitis (n = 14), herpes simplex virus/varicella-zoster virus/cytomegalovirus encephalitis (n = 10), cerebral lymphoma (n = 1), neurosyphilis (n = 1), and mucormycosis (n = 1). In-hospital mortality was 32%; 6-month mortality was 57%. The remaining survivors had either moderate or severe disability (36%) according to Glasgow Outcome Scale. Conclusion: In this setting, patients with CNS infections present late with severe disease and often associated with advanced HIV infection. Tuberculosis, toxoplasmosis, and cryptococcosis are common. High mortality and long-term morbidity underline the need for service improvements and further study.