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. 2012;7(8):e42099.
doi: 10.1371/journal.pone.0042099. Epub 2012 Aug 30.

The spectrum of central nervous system infections in an adult referral hospital in Hanoi, Vietnam

Walter R Taylor  1 , Kinh Nguyen, Duc Nguyen, Huyen Nguyen, Peter Horby, Ha L Nguyen, Trinh Lien, Giang Tran, Ninh Tran, Ha M Nguyen, Thai Nguyen, Ha H Nguyen, Thanh Nguyen, Giap Tran, Jeremy Farrar, Menno de Jong, Constance Schultsz, Huong Tran, Diep Nguyen, Bich Vu, Hoa Le, Trinh Dao, Trung Nguyen, Heiman Wertheim
Affiliations

The spectrum of central nervous system infections in an adult referral hospital in Hanoi, Vietnam

Walter R Taylor et al. PLoS One. 2012.

Abstract

Objectives: To determine prospectively the causative pathogens of central nervous system (CNS) infections in patients admitted to a tertiary referral hospital in Hanoi, Vietnam.

Methods: From May 2007 to December 2008, cerebrospinal fluid (CSF) samples from 352 adults with suspected meningitis or encephalitis underwent routine testing, staining (Gram, Ziehl-Nielsen, India ink), bacterial culture and polymerase chain reaction targeting Neisseria meningitidis, Streptococcus pneumoniae, S. suis, Haemophilus influenzae type b, Herpes simplex virus (HSV), Varicella Zoster virus (VZV), enterovirus, and 16S ribosomal RNA. Blood cultures and clinically indicated radiology were also performed. Patients were classified as having confirmed or suspected bacterial (BM), tuberculous (TBM), cryptococcal (CRM), eosinophilic (EOM) meningitis, aseptic encephalitis/meningitis (AEM), neurocysticercosis and others.

Results: 352 (male: 66%) patients were recruited: median age 34 years (range 13-85). 95/352 (27.3%) diagnoses were laboratory confirmed and one by cranial radiology: BM (n = 62), TBM (n = 9), AEM (n = 19), CRM (n = 5), and neurocysticercosis (n = 1, cranial radiology). S. suis predominated as the cause of BM [48/62 (77.4%)]; Listeria monocytogenese (n = 1), S. pasteurianus (n = 1) and N. meningitidis (n = 2) were infrequent. AEM viruses were: HSV (n = 12), VZV (n = 5) and enterovirus (n = 2). 5 patients had EOM. Of 262/352 (74.4%) patients with full clinical data, 209 (79.8%) were hospital referrals and 186 (71%) had been on antimicrobials. 21 (8%) patients died: TBM (15.2%), AEM (10%), and BM (2.8%).

Conclusions: Most infections lacked microbiological confirmation. S. suis was the most common cause of BM in this setting. Improved diagnostics are needed for meningoencephalitic syndromes to inform treatment and prevention strategies.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Profile of patient numbers with confirmed and clinically diagnosed meningitis or encephalitis.
See this image and copyright information in PMC

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