medigraphic.com
ISSN 1561-302X (Print)

2020, Number 3

<< Back Next >>

Rev cubana med 2020; 59 (3)

Clinical description of patients with central nervous system infections at a tertiary care center

Olivera LIR, Gómez VN, Ruiz GD, Riol JM

Language: Spanish
References: 37
Page: 1-10
PDF size: 326.64 Kb.


ABSTRACT

Introduction: Central nervous system infections constitute a health problem worldwide due to the high morbidity and mortality that it produces.
Objective: To clinically describe patients with central nervous system infection.
Methods: An observational, descriptive and retrospective study was carried out from 2009 to 2018, in patients with central nervous system infection treated at Hermanos Ameijeiras Hospital. The variables studied were age, sex, type of infection, immunocompetence status, clinical manifestations, complications, etiological agents, cellularity in the cerebrospinal fluid, state at discharge, hospital stay.
Results: One hundred thirty three patients were included, 52.6% were male and 45.9% aged between 40-59 years. Patients with bacterial infections prevailed in 58.6%, staphylococcus sp was the most identified etiological agent, meningoencephalitis accounted 36.8%, 56.4% were immunosuppressed, headache and fever were present in 82.7% % and nuchal rigidity in 15%. Respiratory complications and hydrocephalus covered 21% and 12.8% respectively. Status at discharge was associated with immunocompetence status (p = 0.002), hospital stay (p = 0.001) and type of infection (p = 0.002).
Conclusions: Bacterial infection was the main type of infection according to the cellularity predominance; the number of etiological agents identified was low. Meningoencephalitis was the most frequent infection. Headache, fever and nuchal stiffness were the predominant symptoms and signs, as well as respiratory complications and hydrocephalus. There was an association of the state at discharge with the type of infection, immunocompetence status and hospital stay.


REFERENCES

  1. Cabellos Minguez C, Saiz A. Infecciones del sistema nervioso central. En: Medicina Interna. Ed. Farreras/Rozman. Barcelona. 2012;1324-34.

  2. Khatib U, Van de Beek D, Lees JA, Brouwer MC. Adults with suspected central nervous system infection: a prospective study of diagnostic accuracy. Journal of Infection. 2017;74(1):1-9.

  3. Cobian CO, Romero LI, Laguna M, Filiú JL. Aspectos epidemiológicos, clínicos, terapéuticos y evolutivos de la meningoencefalitis bacteriana. Medisan. 2016;20(7):866-74.

  4. Julián Jiménez A, Candel González FJ, González del Castillo J. Utilidad de los biomarcadores de inflamación e infección en los servicios de urgencias. Enferm Infecc Microbiol Clin. 2014;32:177-90.

  5. Flores González JC, Jordán García I, Turón Viñas E, Montero Valladares C, Téllez González C, Fernández Carrión F, et al. Etiología, presentación clínica y evolución neurológica de las encefalitis víricas graves en la edad pediátrica (estudio ECOVE). Rev Neurol. 2015;61:7-13.

  6. Berger JR, Aksamit AJ, Clifford DB, Davis L, Koralnik IJ, Sejvar JJ, et al. PML diagnostic criteria Consensus statement from the AAN Neuroinfectious Disease Section. Neurology. 2013;80:1430-8.

  7. Águeda S, Campos T, Maia A. Prediction of bacterial meningitis based on cerebrospinal fluid pleocytosis in children. Brazilian J Infect Dis. 2013;17:401-4.

  8. Li W, Sun X, Yuan F, Gao Q, Ma Y, Jiang Y, et al. Diagnostic Accuracy of Cerebrospinal Fluid Procalcitonin in Bacterial Meningitis Patients with Empiric Antibiotic Pretreatment. J Clin Microbiol. 2017;55(4):1193-1204.

  9. Rios Sarabia N, Hernández González O, Gordillo G, Vázquez Rosales G, Muñoz-Pérez L, Torres J, Maldonado-Bernal C. Identification of Mycobacterium tuberculosis in the cerebrospinal fluid of patients with meningitis using nested PCR. Int J Mol Med. 2016;38(4):1289-95.

  10. Conca N, Santolaya ME, Farfan MJ, F Cofré, Vergara A, Salazar L, et al. Diagnóstico etiológico en meningitis y encefalitis por técnicas de biología molecular. Rev Chil Pediatr. 2016;87(1):24-30.

  11. Molloy SF, Chiller T, Greene GS, Burry J, Govender NP, Kanyama C, et al. Cryptococcal meningitis: A neglected NTD? PLoS Negl Trop Dis. 2017;11(6):e0005575. https://doi.org/10.1371/journal.pntd.0005575

  12. WHO. The World Heath Report 2016. Available from: http://www.who.int/whr/2016/en

  13. Colectivo de autores. Programa Nacional de prevención y control de Síndromes Neurológicos Infecciosos. La Habana: Minsap; 1999[acceso: 23/02/2020]. Disponible en: http://aps.sld.cu/E/prosni.htlm

  14. López C, Masiá M, Padilla S, Aquilino A, Bas C, Gutiérrez F. Muertes por enfermedades no asociadas directamente con el sida en pacientes con infección por el VIH: un estudio de 14 años (1998-2011). Enf Infec Microb Clín. 2016;34(4):222-7.

  15. Corrales AI, Delgado AE, Pastrana IC, Brown C, Chirino D. Aspectos clínico epidemiológicos de la meningoencefalitis bacteriana: 2002-2006. Rev Ciencias Médicas. 2008;12(2):39-47.

  16. Díaz LP, Calderón Á, Pérez JL, Ruíz MI. Perfil clínico epidemiológico de la meningitis bacteriana. Hospital Camilo Cienfuegos de Sancti Spíritus. 2004-2009. Gaceta Médica Espirituana. 2013[acceso: 23/02/2019];14(1). Disponible en: http://revgmesoirituana.sld.cu/index.php/gme/article/view/114/51

  17. Solomon T, French N. Neurological infections: something for everyone. Lancet Neurol. 2013;12:20-2.

  18. Sgarbi N. Infecciones del sistema nervioso: nuevas herramientas diagnósticas. Rev Argent Radiol. 2015;79(1):12-31.

  19. Riddell J 4th, Shuman EK. Epidemiology of central nervous system infection. Neuroimag Clin N Am. 2012;22:543-56.

  20. Roos Karen L. Bacterial Infections of the Central Nervous System. Continuum (Minneap Minn). 2015;21(6):1679-91.

  21. Choy A, Toraño G, Sánchez ML. Vigilancia de meningitis por Streptococcusp neumoniae en Villa Clara, Cuba, 2012-2013. Revista Cubana de Medicina Tropical. 2014;66(3):465-68.

  22. Figueiras Ramos B, Romero Cabrera Á, López Fernández R, Borroto Lecuona S, Nieto Cabrera R. Caracterización de pacientes con infecciones del sistema nervioso central. Medisur. 2011[acceso: 23/02/2020];9(3). Disponible en: http://www.medisur.sld.cu/index.php/medisur/article/view/1124

  23. Blanchard N, Dunay IR, Schlüter D. Persistence of Toxoplasma gondii in the central nervous system: a fine-tuned balance between the parasite, the brain and the immune system. Parasite Immunol. 2015;37(3):150-8.

  24. Arruti M, Piñeiro LD, Salicio Y, Cilla G, Goenaga MA, de Munain AL. Incidence of varicella zoster virus infections of the central nervous system in the elderly: a large tertiary hospital-based series (2007-2014). J Neur Virol. 2017;23(3):451-9.

  25. Nagel MA, Gilden D. Neurological complications of varicella zoster virus reactivation. Curr Opin Neurol. 2014;27:356-60.

  26. Floren Zabala L, Chamizo López FJ, Eisman Maraver A, Perez Gonzalez C, de Ory Manchon F, Trallero Maso G, et al. Meningitis aséptica en la población adulta. Etiología y utilidad de las técnicas moleculares en el manejo clínico del paciente. Enferm Infecc Microbiol Clin. 2012;30:361-6.

  27. Parisi SG, Basso M, Del Vecchio C, Andreis S, Franchin E, Dal Bello F, et al. Viral infections of the central nervous system in elderly patients: a retrospective study. Int J Infect Dis. 2016;44:8-10.

  28. González F, Huete A, Mercedes L, Zamora RE. Estudio prospectivo y multicéntrico de la epidemiología de las infecciones del sistema nervioso central (meningitis y encefalitis) en los servicios de urgencias hospitalarios: análisis de subgrupo del estudio INFURG-SEMES. Neurología. 2015;30:381-3.

  29. Singh TD, Fugate JE, Rabinstein AA. The spectrum of acute encephalitis: causes, management, and predictors of outcome. Neurology. 2015;84:359-66.

  30. Moon Song M, Kim Tark, Lee Eun M, Joong Koo Kang, Lee Sang-Ahm, Choi Sang-Ho. Comparison of clinical manifestations, outcomes and cerebrospinal fluid findings between herpes simplex type 1 and type 2 central nervous system infections in adults. J Med Virol. 2014;86(10):1766-71.

  31. Pardigon N. Pathophysiological mechanisms of Flavivirus infection of the central nervous system. Trans Clin Biol. 2017;24:96-100.

  32. 32 Sahu R, Verma R, Jain A, Garg RK, Singh MK, Malhotra HS, et at. Neurologic complications in dengue virus infection: a prospective cohort study. Neurology. 2014;83(18):1601-09.

  33. Araújo F, Nogueira R, Araújo Mde S, Perdigão A, Cavalcanti L, Brilhante R, et al. Dengue in patients with central nervous system manifestations, Brazil. Emerg Infect Dis. 2012;18(4):677-79.

  34. Thakur K, Zunt J. Tropical Neuroinfectious Diseases. Continuum (MinneapMinn). 2015;21(6):1639-61.

  35. Brizendine KD, Baddley JW, Pappas PG. Predictors of mortality and differences in clinical features among patients with Cryptococcosis according to immune status. PLoS One. 2013;8(3):604-31.

  36. Başpınar EÖ, Dayan S, Bekçibaşı M, Tekin R, Ayaz C, Deveci Ö, et al. Comparison of culture and PCR methods in the diagnosis of bacterial meningitis. Braz J Microbiol. 2017;48(2):232-6.

  37. Aamer M, Ul Z, Shakir I, Yousaf A, Rasheed A, Wajid R. Sporadic actinomycosis of the hip complicated by Central Nervous System infection. J PakMed Assoc. 2017;67(4):637-40.




2020     |     www.medigraphic.com