Spectrum of central nervous system infections in a tertiary health care centre in Cameroon

Abstract

Background Central nervous system (CNS) infections are serious and debilitating diseases with significant mortality, and high prevalence in the context of human immunodeficiency virus (HIV) pandemic in Africa. However, their diagnosis remains challenging due to outdated technical platform. We aimed to determine the frequency of CNS infection and to describe the epidemiological, clinical and outcome of this at the Douala General Hospital (DGH), Cameroon. To carry out this study, we collected the medical records of patients hospitalized for CNS infections in the internal medicine department of DGH from January 2015 to December 2019. Results Among 8430 files reviewed, 336 cases of CNS infection were identified giving a frequency of CNS infection of 3.99% among which 204 files were included in the study (54.4% were male). HIV infection was found in 147 patients (72.1%) with 38.1% (n = 56) of them on regular follow-up. The most common clinical signs were fever (84.8%), headache (68.6%), meningeal syndrome (38.7%), and seizures (36.3%). Cerebral toxoplasmosis (24.5%), cryptococcal meningitis (21.1%), and acute bacterial meningitis (8.3%) were leading aetiologies. Of the 143 CSF samples, 70.6% (n = 101) were sterile. The in-hospital mortality rate was 23.5% with CNS infection of unknown cause (22.1%) be independently associated to this [OR = 2.24; 95% CI 1.04–4.80, p = 0.039]. Conclusion Clinical presentations of CNS infections are same with classical data. HIV-related opportunistic infections are the main aetiologies. About one over four patients with CNS died. Two thirds of CSF are sterile using basic laboratory assessment giving a need to identify simple tests to increase sensibility and specificity of diagnostic tools in our setting.

Epidemiological characterization of viral etiological agents of the central nervous system infections among hospitalized patients in Egypt between 2016 and 2019

“…The predominance of male patients with viral CNS infection in our study of cases in Egypt was consistent with the findings of other studies in different countries [ 20 – 22 ]. HEV was the most predominant virus in our study, being present in 37.3% of virus-positive samples, which is similar to the results reported by others [ 23 , 24 ].…”

“…Of the 1735 patients who had neurologic symptoms, 330 were confirmed to be positive for a viral pathogen. The mortality associated with viral infection of the CNS is higher than that associated with viral infections of other systems [ 20 ]. Similar to previous global reports, the case fatality rate among the virus-positive cases in our study group was 13%.…”

CD4 Count and Central Nervous System Infection among HIV/AIDS Patients in an Indonesian Presidential Hospital from 2020 to 2022

“…Cerebral toxoplasmosis (76.9%) was the most common diagnosis of central nervous system infections among the patients. Several prior studies support the results of this study, identifying cerebral toxoplasmosis as the most prevalent diagnosis for neurological manifestations (Rahmayanti et al 2019, Massi et al 2022). However, the results of this study differed from the research conducted by Fatimatuzzahra et al (2022) at Dr. Hasan Sadikin Central General Hospital, Bandung, Indonesia.…”

A prospective study of nanopore-targeted sequencing in the diagnosis of central nervous system infections

“…Central nervous system (CNS) infections are a group of neurological diseases, with varying symptoms according to the type of infection, the causative agent, and the location where they occur ( 1 ). However, due to the overlapping and nonspecific symptoms of CNS infections at early stages, the definitive etiologic diagnosis is difficult to make, leading to high mortality and morbidity ( 2 , 3 ).…”