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

Darma Imran, Riwanti Estiasari, Kartika Maharani, Sucipto, Delly Chipta Lestari, Reyhan Eddy Yunus, Evy Yunihastuti, Teguh Haryono Karyadi, Diana Oei, Ina S. Timan, Dewi Wulandari, Retno Wahyuningsih, Robiatul Adawiyah, Agnes Kurniawan, Rahmad Mulyadi, Anis Karuniawati, Ungke Anton Jaya, Dodi Safari, Arjan Van Laarhoven, Bachti AlisjahbanaSofiati Dian, Lidya Chaidir, Ahmad Rizal Ganiem, Diatri Nari Lastri, Khin Saw Aye Myint, Reinout Van Crevel

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

BackgroundLittle detailed knowledge is available regarding the etiology and outcome of CNS infection, particularly in HIV-infected individuals, in low-resource settings.MethodsFrom 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.ResultsA 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.ConclusionIn 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 languageEnglish
Pages (from-to)379-388
Number of pages10
JournalNeurology: Clinical Practice
Volume8
Issue number5
DOIs
Publication statusPublished - 1 Jan 2018

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