Pattern of CNS infections presenting to a Teaching Hospital

Abstract

OBJECTIVE: Central nervous system (CNS) infections cause high morbidity and mortality, but data from Sri Lanka are limited. We aimed to describe the pattern of CNS infections presenting to a tertiary care hospital DESIGN, SETTING AND METHODS: We prospectively studied all patients with suspected CNS infection admitted to the medical units of the Colombo North Teaching Hospital over a six-month period. Data were collected on demographic and clinical features, laboratory findings, treatments given and immediate outcome. RESULTS: Fifty patients were studied [64% males, mean age (SD) - 39.4(20.2) years]. Fever (90%), altered consciousness (80%), headache (66%), behavioural change (50%) and neck stiffness (52%) were the commonest findings on presentation. Seizures were seen in 28%, and focal deficits were rare (6%). Blood cultures, blood films for malarial parasites, CSF Gram stains and CSF-eultures were negative. CT scanning was not helpful in diagnosis. A diagnosis of presumed meningitis or encephalitis was made in 36% patients, based on CSF cytology or EEC findings. A definitive aetiological/ microbiological diagnosis was not possible in any patient. All patients were treated with intravenous antibiotics +/- intravenous acyclovir on empiric grounds, without microbiological confirmation. Six patients (12%) died in hospital. CONCLUSIONS: Diagnosis of CNS infections is highly unsatisfactory with the available facilities, even in a tertiary care setting.