Aetiology and Outcomes of Suspected Infections of the Central Nervous System in Children in Mbarara, Uganda

Abstract

Infections of the central nervous system (CNS) are severe conditions, leading to neurological sequelae or death. Knowledge of the causative agents is essential to develop guidelines for case management in resource-limited settings. Between August 2009 and October 2012, we conducted a prospective descriptive study of the aetiology of suspected CNS infections in children two months to 12 years old, with fever and at least one sign of CNS involvement in Mbarara Hospital, Uganda. Children were clinically evaluated on admission and discharge, and followed-up for 6 months for neurological sequelae. Pathogens were identified from cerebrospinal fluid (CSF) and blood using microbiological and molecular methods. We enrolled 459 children. Plasmodium falciparum (36.2%) and bacteria in CSF (13.3%) or blood (3.3%) were the most detected pathogens. Viruses were found in 27 (5.9%) children. No pathogen was isolated in 207 (45.1%) children. Patterns varied by age and HIV status. Eighty-three (18.1%) children died during hospitalisation, and 23 (5.0%) during follow-up. Forty-one (13.5%) children had neurological sequelae at the last visit. While malaria remains the main aetiology in children with suspected CNS infections, no pathogen was isolated in many children. The high mortality and high rate of neurological sequelae highlight the need for efficient diagnosis.

Antimicrobial treatment practices among Ugandan children with suspicion of central nervous system infection

“…Children who met the criteria above were enrolled into a prospective descriptive cohort study between August 2009 and October 2012. A more complete description of the study population and methods is provided elsewhere [ 11 ].…”

“…Socio-demographic and clinical characteristics of the participants including age, gender, HIV exposure, history and type of previous treatment as well as clinical information at admission and discharge and treatment received were recorded in a standardized case report form [ 11 ]. Diagnosis at admission was based on clinical examination and systematic testing with a rapid diagnostic test for malaria (SD-Bioline Malaria Antigen P.f/Pan, Standard Diagnostics, Korea).…”

“…CSF was aseptically obtained by lumbar puncture into sterile CSF tubes. To diagnose bacterial pathogens, blood and CSF were analyzed at the Epicentre research laboratory on site following standardized bacteriology procedures [ 11 ]. Culture, staining, biochemical testing were used to identify any bacterial pathogens present.…”

“…We focus on malaria and bacterial infections because of the limited ability to diagnose and assess treatment for viral infections. This is a secondary analysis of data collected within a study of the aetiology of suspected CNS infections published elsewhere [ 11 ].…”

Combined testing for herpes simplex virus and Mycobacterium tuberculosis DNA in cerebrospinal fluid of patients with aseptic meningitis in Burkina Faso, West Africa

“…[46][47][48] In a recent study in Uganda, a diagnosis of tuberculous meningitis was confirmed in 4% of children suspected of meningitis. 49 Data are missing in West African countries where HIV prevalence is lower.…”