Giuseppe
Emeritus
[Source: PLoS ONE, full text: (LINK). Abstract, edited.]
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The Spectrum of Central Nervous System Infections in an Adult Referral Hospital in Hanoi, Vietnam
Walter R. Taylor<SUP>1</SUP><SUP>,</SUP><SUP>2</SUP><SUP>*</SUP>, Kinh Nguyen<SUP>3</SUP>, Duc Nguyen<SUP>3</SUP>, Huyen Nguyen<SUP>3</SUP>, Peter Horby<SUP>1</SUP><SUP>,</SUP><SUP>2</SUP>, Ha L. Nguyen<SUP>3</SUP>, Trinh Lien<SUP>3</SUP>, Giang Tran<SUP>3</SUP>, Ninh Tran<SUP>3</SUP>, Ha M. Nguyen<SUP>3</SUP>, Thai Nguyen<SUP>3</SUP>, Ha H. Nguyen<SUP>3</SUP>, Thanh Nguyen<SUP>3</SUP>, Giap Tran<SUP>3</SUP>, Jeremy Farrar<SUP>2</SUP><SUP>,</SUP><SUP>4</SUP>, Menno de Jong<SUP>2</SUP><SUP>,</SUP><SUP>4</SUP>, Constance Schultsz<SUP>2</SUP><SUP>,</SUP><SUP>4</SUP>, Huong Tran<SUP>3</SUP>, Diep Nguyen<SUP>3</SUP>, Bich Vu<SUP>3</SUP>, Hoa Le<SUP>3</SUP>, Trinh Dao<SUP>3</SUP>, Trung Nguyen<SUP>3</SUP>, Heiman Wertheim<SUP>1</SUP><SUP>,</SUP><SUP>2</SUP>
<SUP></SUP>
1 Oxford University Clinical Research Unit, Hanoi, Vietnam, 2 Centre for Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, United Kingdom, 3 National Hospital for Tropical Diseases, Hanoi, Vietnam, 4 Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
Abstract
Objectives
To determine prospectively the causative pathogens of central nervous system (CNS) infections in patients admitted to a tertiary referral hospital in Hanoi, Vietnam.
Methods
From May 2007 to December 2008, cerebrospinal fluid (CSF) samples from 352 adults with suspected meningitis or encephalitis underwent routine testing, staining (Gram, Ziehl-Nielsen, India ink), bacterial culture and polymerase chain reaction targeting Neisseria meningitidis, Streptococcus pneumoniae, S. suis, Haemophilus influenzae type b, Herpes simplex virus (HSV), Varicella Zoster virus (VZV), enterovirus, and 16S ribosomal RNA. Blood cultures and clinically indicated radiology were also performed. Patients were classified as having confirmed or suspected bacterial (BM), tuberculous (TBM), cryptococcal (CRM), eosinophilic (EOM) meningitis, aseptic encephalitis/meningitis (AEM), neurocysticercosis and others.
Results
352 (male: 66%) patients were recruited: median age 34 years (range 13?85). 95/352 (27.3%) diagnoses were laboratory confirmed and one by cranial radiology: BM (n = 62), TBM (n = 9), AEM (n = 19), CRM (n = 5), and neurocysticercosis (n = 1, cranial radiology). S. suis predominated as the cause of BM [48/62 (77.4%)]; Listeria monocytogenese (n = 1), S. pasteurianus (n = 1) and N. meningitidis (n = 2) were infrequent. AEM viruses were: HSV (n = 12), VZV (n = 5) and enterovirus (n = 2). 5 patients had EOM. Of 262/352 (74.4%) patients with full clinical data, 209 (79.8%) were hospital referrals and 186 (71%) had been on antimicrobials. 21 (8%) patients died: TBM (15.2%), AEM (10%), and BM (2.8%).
Conclusions
Most infections lacked microbiological confirmation. S. suis was the most common cause of BM in this setting. Improved diagnostics are needed for meningoencephalitic syndromes to inform treatment and prevention strategies.
Citation: Taylor WR, Nguyen K, Nguyen D, Nguyen H, Horby P, et al. (2012) The Spectrum of Central Nervous System Infections in an Adult Referral Hospital in Hanoi, Vietnam. PLoS ONE 7(8): e42099. doi:10.1371/journal.pone.0042099
Editor: Jose Antonio Stoute, Pennsylvania State University College of Medicine, United States of America
Received: February 14, 2012; Accepted: July 2, 2012; Published: August 30, 2012
Copyright: ? 2012 Taylor et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The funding for this study came from core funds, provided mostly by the Wellcome Trust of Grat Britain. No additional external funding received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
* E-mail: bob@tropmedres.ac
-Walter R. Taylor<SUP>1</SUP><SUP>,</SUP><SUP>2</SUP><SUP>*</SUP>, Kinh Nguyen<SUP>3</SUP>, Duc Nguyen<SUP>3</SUP>, Huyen Nguyen<SUP>3</SUP>, Peter Horby<SUP>1</SUP><SUP>,</SUP><SUP>2</SUP>, Ha L. Nguyen<SUP>3</SUP>, Trinh Lien<SUP>3</SUP>, Giang Tran<SUP>3</SUP>, Ninh Tran<SUP>3</SUP>, Ha M. Nguyen<SUP>3</SUP>, Thai Nguyen<SUP>3</SUP>, Ha H. Nguyen<SUP>3</SUP>, Thanh Nguyen<SUP>3</SUP>, Giap Tran<SUP>3</SUP>, Jeremy Farrar<SUP>2</SUP><SUP>,</SUP><SUP>4</SUP>, Menno de Jong<SUP>2</SUP><SUP>,</SUP><SUP>4</SUP>, Constance Schultsz<SUP>2</SUP><SUP>,</SUP><SUP>4</SUP>, Huong Tran<SUP>3</SUP>, Diep Nguyen<SUP>3</SUP>, Bich Vu<SUP>3</SUP>, Hoa Le<SUP>3</SUP>, Trinh Dao<SUP>3</SUP>, Trung Nguyen<SUP>3</SUP>, Heiman Wertheim<SUP>1</SUP><SUP>,</SUP><SUP>2</SUP>
<SUP></SUP>
1 Oxford University Clinical Research Unit, Hanoi, Vietnam, 2 Centre for Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, United Kingdom, 3 National Hospital for Tropical Diseases, Hanoi, Vietnam, 4 Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
Abstract
Objectives
To determine prospectively the causative pathogens of central nervous system (CNS) infections in patients admitted to a tertiary referral hospital in Hanoi, Vietnam.
Methods
From May 2007 to December 2008, cerebrospinal fluid (CSF) samples from 352 adults with suspected meningitis or encephalitis underwent routine testing, staining (Gram, Ziehl-Nielsen, India ink), bacterial culture and polymerase chain reaction targeting Neisseria meningitidis, Streptococcus pneumoniae, S. suis, Haemophilus influenzae type b, Herpes simplex virus (HSV), Varicella Zoster virus (VZV), enterovirus, and 16S ribosomal RNA. Blood cultures and clinically indicated radiology were also performed. Patients were classified as having confirmed or suspected bacterial (BM), tuberculous (TBM), cryptococcal (CRM), eosinophilic (EOM) meningitis, aseptic encephalitis/meningitis (AEM), neurocysticercosis and others.
Results
352 (male: 66%) patients were recruited: median age 34 years (range 13?85). 95/352 (27.3%) diagnoses were laboratory confirmed and one by cranial radiology: BM (n = 62), TBM (n = 9), AEM (n = 19), CRM (n = 5), and neurocysticercosis (n = 1, cranial radiology). S. suis predominated as the cause of BM [48/62 (77.4%)]; Listeria monocytogenese (n = 1), S. pasteurianus (n = 1) and N. meningitidis (n = 2) were infrequent. AEM viruses were: HSV (n = 12), VZV (n = 5) and enterovirus (n = 2). 5 patients had EOM. Of 262/352 (74.4%) patients with full clinical data, 209 (79.8%) were hospital referrals and 186 (71%) had been on antimicrobials. 21 (8%) patients died: TBM (15.2%), AEM (10%), and BM (2.8%).
Conclusions
Most infections lacked microbiological confirmation. S. suis was the most common cause of BM in this setting. Improved diagnostics are needed for meningoencephalitic syndromes to inform treatment and prevention strategies.
Citation: Taylor WR, Nguyen K, Nguyen D, Nguyen H, Horby P, et al. (2012) The Spectrum of Central Nervous System Infections in an Adult Referral Hospital in Hanoi, Vietnam. PLoS ONE 7(8): e42099. doi:10.1371/journal.pone.0042099
Editor: Jose Antonio Stoute, Pennsylvania State University College of Medicine, United States of America
Received: February 14, 2012; Accepted: July 2, 2012; Published: August 30, 2012
Copyright: ? 2012 Taylor et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The funding for this study came from core funds, provided mostly by the Wellcome Trust of Grat Britain. No additional external funding received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
* E-mail: bob@tropmedres.ac
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