Tuberculous meningitis is a major cause of mortality and morbidity in adults with central nervous system infections in Kota Kinabalu, Sabah, Malaysia: an observational study

BMC Infectious Diseases

Research Article

Heng Gee Lee¹  Jayaram Menon¹  Timothy William²  Anna P. Ralph³  Tsin Wen Yeo⁴  Eng Eong Ooi⁵  October Sessions⁵  Yan’an Hou⁵ 

[1] Department of Medicine, The Infectious Disease Unit, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia;Department of Medicine, The Infectious Disease Unit, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia;Jesselton Medical Centre, Kota Kinabalu, Sabah, Malaysia;Menzies School of Health Research, Darwin, Australia;Menzies School of Health Research, Darwin, Australia;Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore;Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore;Program in Emerging Infectious Diseases, Duke-NUS Graduate Medical School, Singapore, Singapore;

关键词: Central nervous system infections;    Tuberculous meningitis;    Meningitis;    Encephalitis;    Meningo-encephalitis;   

DOI  :  10.1186/s12879-016-1640-x

 received in 2015-10-02, accepted in 2016-06-07,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundCentral nervous system (CNS) infections are a significant contributor to morbidity and mortality globally. However, most published studies have been conducted in developed countries where the epidemiology and aetiology differ significantly from less developed areas. Additionally, there may be regional differences due to variation in the socio-economic levels, public health services and vaccination policies. Currently, no prospective studies have been conducted in Sabah, East Malaysia to define the epidemiology and aetiology of CNS infections. A better understanding of these is essential for the development of local guidelines for diagnosis and management.MethodsWe conducted a prospective observational cohort study in patients aged 12 years and older with suspected central nervous system infections at Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia between February 2012 and March 2013. Cerebrospinal fluid was sent for microscopy, biochemistry, bacterial and mycobacterial cultures, Mycobacterium tuberculosis polymerase chain reaction (PCR), and multiplex and MassCode PCR for various viral and bacterial pathogens.ResultsA total of 84 patients with clinically suspected meningitis and encephalitis were enrolled. An aetiological agent was confirmed in 37/84 (44 %) of the patients. The most common diagnoses were tuberculous meningitis (TBM) (41/84, 48.8 %) and cryptococcal meningoencephalitis (14/84, 16.6 %). Mycobacterium tuberculosis was confirmed in 13/41 (31.7 %) clinically diagnosed TBM patients by cerebrospinal fluid PCR or culture. The acute case fatality rate during hospital admission was 16/84 (19 %) in all patients, 4/43 (9 %) in non-TBM, and 12/41 (29 %) in TBM patients respectively (p = 0.02).ConclusionTBM is the most common cause of CNS infection in patients aged 12 years or older in Kota Kinabalu, Sabah, Malaysia and is associated with high mortality and morbidity. Further studies are required to improve the management and outcome of TBM.

【 授权许可】

CC BY   
© The Author(s). 2016