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. 2018 Oct;8(5):379-388.
doi: 10.1212/CPJ.0000000000000517.

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

Darma Imran  1 , Riwanti Estiasari  1 , Kartika Maharani  1 , Sucipto  1 , Delly Chipta Lestari  1 , Reyhan Eddy Yunus  1 , Evy Yunihastuti  1 , Teguh Haryono Karyadi  1 , Diana Oei  1 , Ina S Timan  1 , Dewi Wulandari  1 , Retno Wahyuningsih  1 , Robiatul Adawiyah  1 , Agnes Kurniawan  1 , Rahmad Mulyadi  1 , Anis Karuniawati  1 , Ungke Anton Jaya  1 , Dodi Safari  1 , Arjan van Laarhoven  1 , Bachti Alisjahbana  1 , Sofiati Dian  1 , Lidya Chaidir  1 , Ahmad Rizal Ganiem  1 , Diatri Nari Lastri  1 , Khin Saw Aye Myint  1 , Reinout van Crevel  1
Affiliations

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

Darma Imran et al. Neurol Clin Pract. 2018 Oct.

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.

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Figures

Figure 1
Figure 1. Patients presenting with suspected CNS infection
CMV = cytomegalovirus; IgG = immunoglobulin G; TB = tuberculosis.
Figure 2
Figure 2. Relative proportion of different diagnoses (including definite diagnoses and probable tuberculous meningitis and toxoplasmosis) according to HIV status
Figure 3
Figure 3. Survival stratified by HIV status
See this image and copyright information in PMC

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