Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec 1;11(1):23235.
doi: 10.1038/s41598-021-02592-6.

A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017-2018

Paola Mariela Saba Villarroel  1   2 , María Del Rosario Castro Soto  3 , Oriana Melendres Flores  4 , Alejandro Peralta Landívar  5 , María E Calderón  6 , Roxana Loayza  7 , José Boucraut  8   9 , Laurence Thirion  10 , Audrey Dubot-Pérès  10 , Laetitia Ninove  10 , Xavier de Lamballerie  10
Affiliations

A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017-2018

Paola Mariela Saba Villarroel et al. Sci Rep. .

Abstract

Central nervous system (CNS) infections are important causes of morbidity and mortality worldwide. In Bolivia, aetiologies, case fatality, and determinants of outcome are poorly characterised. We attempted to investigate such parameters to guide diagnosis, treatment, prevention, and health policy. From Nov-2017 to Oct-2018, we prospectively enrolled 257 inpatients (20.2% HIV-positive patients) of all ages from healthcare centers of Cochabamba and Santa Cruz, Bolivia with a suspected CNS infection and a lumbar puncture performed. Biological diagnosis included classical microbiology, molecular, serological and immunohistochemical tests. An infectious aetiology was confirmed in 128/257 (49.8%) inpatients, including, notably among confirmed single and co-infections, Cryptococcus spp. (41.7%) and Mycobacterium tuberculosis (27.8%) in HIV-positive patients, and Mycobacterium tuberculosis (26.1%) and Streptococcus pneumoniae (18.5%) in HIV-negative patients. The total mortality rate was high (94/223, 42.1%), including six rabies cases. In multivariate logistic regression analysis, mortality was associated with thrombocytopenia (Odds ratio (OR) 5.40, 95%-CI 2.40-11.83) and hydrocephalus (OR 4.07, 95%-CI 1.35-12.23). The proportion of untreated HIV patients, late presentations of neurotuberculosis, the rate of pneumococcal cases, and rabies patients who did not benefit from a post-exposure prophylaxis, suggest that decreasing the burden of CNS infections requires reinforcing health policy regarding tuberculosis, rabies, S. pneumoniae vaccination, and HIV-infections.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Distribution of patients with suspected central nervous system infection by confirmed, probable and possible infectious aetiology, non-infectious and unknown aetiology. Bolivia, 2017–2018.
Figure 2
Figure 2
Aetiologies distribution of patients with suspected central nervous system infection by HIV status. Bolivia 2017–2018.
Figure 3
Figure 3
Clinical outcome of patients with suspected central nervous system infection by aetiology. Bolivia 2017–2018.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Giri A, et al. Aetiologies of central nervous system infections in adults in Kathmandu, Nepal: a prospective hospital-based study. Sci. Rep. 2013;3:2382. doi: 10.1038/srep02382. - DOI - PMC - PubMed
    1. Lancaster E. The Diagnosis and Treatment of Autoimmune Encephalitis. J. Clin. Neurol. 2016;12:1–13. doi: 10.3988/jcn.2016.12.1.1. - DOI - PMC - PubMed
    1. Dubot-Pérès A, et al. Management of Central Nervous System Infections, Vientiane, Laos, 2003–2011. Emerg. Infect. Dis. 2019;25:898–910. doi: 10.3201/eid2505.180914. - DOI - PMC - PubMed
    1. Pobreza y Desigualdad. INEhttps://www.ine.gob.bo/index.php/estadisticas-economicas/encuestas-de-ho....
    1. Perfil de los Sistemas de Salud - Bolivia. 58.

Publication types

MeSH terms