Aetiologies of Central Nervous System Infections: A Study at Tertiary Care Hospital in Northern Punjab

Abstract

Objective: To identify demographic patterns and etiologies of CNS infections and to identify the clinical presentations, diagnostic accuracy, and clinical outcomes of various CNS infections in hospitalized patients in a tertiary care hospital.

Study Design: Cross sectional study.

Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Oct 2019 to Jun 2020.

Methodology: A total of 97 adult patients presenting with clinical features of Central Nervous System (CNS) infection were enrolled for this in-hospital study. Cerebrospinal fluid (CSF) was collected for a routine examination, bacterial culture, and viral Polymerase Chain Reaction (PCR) test. Human Immunodeficiency Virus (HIV) serology and neuroimaging were done in all cases. The diagnosis was established based on World Health Organization guidelines for infectious diseases. Infections were classified into four major categories for analysis purposes.

Results: Of 97 enrolled patients, the mean age was 38.8±18.5 years. CNS tuberculosis was the most common infection seen in 46(47.4%) cases, 25(25.7%) patients had viral encephalitis, and 17(17.5%) had bacterial meningitis. The rest of the patients (n=9) had fungal (3%) or parasitic infections (4%). In contrast, two patients were found to have focal cerebritis, one due to Brucella and the other due to Salmonella typhi.

Conclusion: Tuberculosis is the most common (CNS infection in this region. First, patients with CNS infections, especially chronic ones, present very late in our setting, leading to increased morbidity and mortality. Secondly, Molecular diagnosis is obtainable in only a small percentage of cases for various reasons.