Presentation, etiology, and outcome of brain infections in an Indonesian hospital: A cohort study.

D Imran; R Estiasari; K Maharani; Aegerin Hafiz Sucipto; DC Lestari; RE Yunus; E Yunihastuti; TH Karyadi; D Oei; IS Timan; D Wulandari; R Wahyuningsih; R Adawiyah; A Kurniawan; R Mulyadi; A Karuniawati; UA Jaya; D Safari; Laarhoven A van; B Alisjahbana; S Dian; L Chaidir; AR Ganiem; DN Lastri; Myint KS Aye; Crevel R van; Agnes Kurniawan

doi:10.1212/CPJ.0000000000000517

Presentation, etiology, and outcome of brain infections in an Indonesian hospital: A cohort study.

D Imran, R Estiasari, K Maharani, Aegerin Hafiz Sucipto, DC Lestari, RE Yunus, E Yunihastuti, TH Karyadi, D Oei, IS Timan, D Wulandari, R Wahyuningsih, R Adawiyah, A Kurniawan, R Mulyadi, A Karuniawati, UA Jaya, D Safari, Laarhoven A van, B AlisjahbanaS Dian, L Chaidir, AR Ganiem, DN Lastri, Myint KS Aye, Crevel R van, Agnes Kurniawan

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Abstract

Little detailed knowledge is available regarding the etiology and outcome of CNS infection, particularly in HIV-infected individuals, in low-resource settings.

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.

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.

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.

Original language	English
Pages (from-to)	379-388
Number of pages	10
Journal	Neurology: Clinical Practice
Volume	8
Issue number	5
DOIs	https://doi.org/10.1212/CPJ.0000000000000517
Publication status	Published - 1 Oct 2018

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Imran, D., Estiasari, R., Maharani, K., Sucipto, A. H., Lestari, DC., Yunus, RE., Yunihastuti, E., Karyadi, TH., Oei, D., Timan, IS., Wulandari, D., Wahyuningsih, R., Adawiyah, R., Kurniawan, A., Mulyadi, R., Karuniawati, A., Jaya, UA., Safari, D., van, L. A., ... Kurniawan, A. (2018). Presentation, etiology, and outcome of brain infections in an Indonesian hospital: A cohort study. Neurology: Clinical Practice, 8(5), 379-388. https://doi.org/10.1212/CPJ.0000000000000517

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title = "Presentation, etiology, and outcome of brain infections in an Indonesian hospital: A cohort study.",

abstract = "Little detailed knowledge is available regarding the etiology and outcome of CNS infection, particularly in HIV-infected individuals, in low-resource settings.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.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.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.",

author = "D Imran and R Estiasari and K Maharani and Sucipto, {Aegerin Hafiz} and DC Lestari and RE Yunus and E Yunihastuti and TH Karyadi and D Oei and IS Timan and D Wulandari and R Wahyuningsih and R Adawiyah and A Kurniawan and R Mulyadi and A Karuniawati and UA Jaya and D Safari and van, {Laarhoven A} and B Alisjahbana and S Dian and L Chaidir and AR Ganiem and DN Lastri and Aye, {Myint KS} and van, {Crevel R} and Agnes Kurniawan",

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Imran, D, Estiasari, R, Maharani, K, Sucipto, AH, Lestari, DC , Yunus, RE , Yunihastuti, E , Karyadi, TH, Oei, D, Timan, IS, Wulandari, D, Wahyuningsih, R, Adawiyah, R , Kurniawan, A , Mulyadi, R , Karuniawati, A, Jaya, UA, Safari, D, van, LA, Alisjahbana, B, Dian, S, Chaidir, L, Ganiem, AR, Lastri, DN, Aye, MKS, van, CR & Kurniawan, A 2018, 'Presentation, etiology, and outcome of brain infections in an Indonesian hospital: A cohort study.', Neurology: Clinical Practice, vol. 8, no. 5, pp. 379-388. https://doi.org/10.1212/CPJ.0000000000000517

TY - JOUR

T1 - Presentation, etiology, and outcome of brain infections in an Indonesian hospital

T2 - A cohort study.

AU - Imran, D

AU - Estiasari, R

AU - Maharani, K

AU - Sucipto, Aegerin Hafiz

AU - Lestari, DC

AU - Yunus, RE

AU - Yunihastuti, E

AU - Karyadi, TH

AU - Oei, D

AU - Timan, IS

AU - Wulandari, D

AU - Wahyuningsih, R

AU - Adawiyah, R

AU - Kurniawan, A

AU - Mulyadi, R

AU - Karuniawati, A

AU - Jaya, UA

AU - Safari, D

AU - van, Laarhoven A

AU - Alisjahbana, B

AU - Dian, S

AU - Chaidir, L

AU - Ganiem, AR

AU - Lastri, DN

AU - Aye, Myint KS

AU - van, Crevel R

AU - Kurniawan, Agnes

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Little detailed knowledge is available regarding the etiology and outcome of CNS infection, particularly in HIV-infected individuals, in low-resource settings.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.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.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.

AB - Little detailed knowledge is available regarding the etiology and outcome of CNS infection, particularly in HIV-infected individuals, in low-resource settings.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.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.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.

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U2 - 10.1212/CPJ.0000000000000517

DO - 10.1212/CPJ.0000000000000517

M3 - Article

C2 - 30564491

SN - 2163-0402

VL - 8

SP - 379

EP - 388

JO - Neurology: Clinical Practice

JF - Neurology: Clinical Practice

IS - 5

ER -

Presentation, etiology, and outcome of brain infections in an Indonesian hospital: A cohort study.

Abstract

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