Clinical profile and difficulties in diagnosis of central nervous system infections in adult patients in a tertiary care hospital

摘要

Objectives We aimed to describe the pattern of central nervous system (CNS) infections and accuracy of diagnosis in a Sri Lankan tertiary care hospital. Methods We prospectively studied all adult patients with suspected CNS infection admitted over a two-year period. Data were collected on demographic and clinical features, laboratory findings, treatment and immediate outcome. Diagnosis of CNS infection was categorized as definite, probable, possible and uncertain. Results We studied 215 patients [59.1% males; mean age (SD) 44 (20) years]. Blood cultures were done in 65 (30.2%) and only one was positive. Lumbar puncture was done in 146 (67.9%), and cerebrospinal fluid Gram stains, culture and acid-fast bacilli stains were all negative. Diagnosis of CNS infection was considered ‘definite’ in only one patient, ‘probable’ in 57.2%, ‘possible’ in 5.6%, and ‘uncertain’ in 26%. An alternative diagnosis was found in 23 patients (10.7%). Intravenous antibiotics and aciclovir were given on emperical grounds, largely without microbiological confirmation. Conclusions Diagnosis of CNS infections is highly unsatisfactory with available facilities, even in a tertiary care setting. DOI: http://dx.doi.org/10.4038/cmj.v58i1.5360 Ceylon Medical Journal 2013; 58: 26-28