The Spectrum of Central Nervous System Infections in an Adult Referral Hospital in Hanoi, Vietnam

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.

[1]  J. Farrar,et al.  Risk Factors of Streptococcus suis Infection in Vietnam. A Case-Control Study , 2011, PloS one.

[2]  J. Farrar,et al.  Viral Etiology of Encephalitis in Children in Southern Vietnam: Results of a One-Year Prospective Descriptive Study , 2010, PLoS neglected tropical diseases.

[3]  J. Farrar,et al.  Three Adult Cases of Listeria monocytogenes Meningitis in Vietnam , 2010, PLoS medicine.

[4]  J. Rhee,et al.  Changing etiology of community-acquired bacterial meningitis in adults: a nationwide multicenter study in Korea , 2010, European Journal of Clinical Microbiology & Infectious Diseases.

[5]  N. Beeching,et al.  Effect of delayed lumbar punctures on the diagnosis of acute bacterial meningitis in adults , 2010, Emergency Medicine Journal.

[6]  M. Blaser,et al.  Streptococcus gallolyticus Subspecies pasteurianus (Biotype II/2), a Newly Reported Cause of Adult Meningitis , 2010, Journal of Clinical Microbiology.

[7]  A. Abdulrab,et al.  Acute bacterial meningitis in adults: a hospital based study in Yemen. , 2010, Japanese journal of infectious diseases.

[8]  T. V. Tuan,et al.  Immunological and biochemical correlates of adjunctive dexamethasone in Vietnamese adults with bacterial meningitis. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[9]  Hong Ha Nguyen,et al.  Acute febrile myalgia in Vietnam due to trichinellosis following the consumption of raw pork. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[10]  O. Levine,et al.  Sequelae due to bacterial meningitis among African children: a systematic literature review , 2009, BMC medicine.

[11]  G. Scott,et al.  British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. , 2009, The Journal of infection.

[12]  P. Horby,et al.  Streptococcus suis, an Important Cause of Adult Bacterial Meningitis in Northern Vietnam , 2009, PloS one.

[13]  S. Rai,et al.  Parasite egg contamination of vegetables from a suburban market in Hanoi, Vietnam. , 2009, Nepal Medical College journal : NMCJ.

[14]  M. Capoor,et al.  Outbreak of meningococcal disease in and around New Delhi, India, 2005–2006: a report from a tertiary care hospital , 2008, Epidemiology and Infection.

[15]  P. Dayan,et al.  Effect of Antibiotic Pretreatment on Cerebrospinal Fluid Profiles of Children With Bacterial Meningitis , 2008, Pediatrics.

[16]  T. Solomon,et al.  The epidemiology, clinical features, and long-term prognosis of Japanese encephalitis in central sarawak, malaysia, 1997-2005. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[17]  N. Segami,et al.  Bacterial diversity in synovial fluids of patients with TMD determined by cloning and sequencing analysis of the 16S ribosomal RNA gene. , 2008, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[18]  J. Farrar,et al.  Clinical and Microbiological Features of HIV-Associated Tuberculous Meningitis in Vietnamese Adults , 2008, PloS one.

[19]  J. Farrar,et al.  Streptococcus suis meningitis in adults in Vietnam. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[20]  N. M. Duong,et al.  Dexamethasone in Vietnamese adolescents and adults with bacterial meningitis. , 2007, The New England journal of medicine.

[21]  J. Farrar,et al.  Validation of a diagnostic algorithm for adult tuberculous meningitis. , 2007, The American journal of tropical medicine and hygiene.

[22]  B. Riou,et al.  Accuracy of the cerebrospinal fluid results to differentiate bacterial from non bacterial meningitis, in case of negative gram-stained smear. , 2007, The American journal of emergency medicine.

[23]  F. Schuster,et al.  Beyond viruses: clinical profiles and etiologies associated with encephalitis. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[24]  A. Tunkel.  Dexamethasone for treatment of tuberculous meningitis in adolescents and adults , 2005, Current infectious disease reports.

[25]  V. Guillaume,et al.  Specific detection of Nipah virus using real-time RT-PCR (TaqMan). , 2004, Journal of virological methods.

[26]  M. Beld,et al.  Highly Sensitive Assay for Detection of Enterovirus in Clinical Specimens by Reverse Transcription-PCR with an Armored RNA Internal Control , 2004, Journal of Clinical Microbiology.

[27]  J. Farrar,et al.  Comparison of Conventional Bacteriology with Nucleic Acid Amplification (Amplified Mycobacterium Direct Test) for Diagnosis of Tuberculous Meningitis before and after Inception of Antituberculosis Chemotherapy , 2004, Journal of Clinical Microbiology.

[28]  J. Farrar,et al.  Improving the Bacteriological Diagnosis of Tuberculous Meningitis , 2004, Journal of Clinical Microbiology.

[29]  A. Osterhaus,et al.  Diagnosing Herpesvirus Infections by Real-Time Amplification and Rapid Culture , 2003, Journal of Clinical Microbiology.

[30]  K Stepniewska,et al.  Diagnosis of adult tuberculous meningitis by use of clinical and laboratory features , 2002, The Lancet.

[31]  K. Thomas,et al.  The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[32]  P. Trieu-Cuot,et al.  Taxonomic dissection of the Streptococcus bovis group by analysis of manganese-dependent superoxide dismutase gene (sodA) sequences: reclassification of 'Streptococcus infantarius subsp. coli' as Streptococcus lutetiensis sp. nov. and of Streptococcus bovis biotype 11.2 as Streptococcus pasteurianus , 2002, International journal of systematic and evolutionary microbiology.

[33]  M. Cardosa,et al.  Antibodies against prM protein distinguish between previous infection with dengue and Japanese encephalitis viruses. , 2002, BMC Microbiology.

[34]  A. Mert,et al.  Tuberculous meningits in adults in Turkey: Epidemiology, diagnosis, clinic and laboratory , 2002, European Journal of Epidemiology.

[35]  R. Thomson,,et al.  Laboratory diagnosis of central nervous system infections. , 2001, Infectious disease clinics of North America.

[36]  P. Tambyah,et al.  Listeria meningoencephalitis: two cases and a review of the literature. , 2001, Annals of the Academy of Medicine, Singapore.

[37]  R. Borrow,et al.  Simultaneous Detection of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae in Suspected Cases of Meningitis and Septicemia Using Real-Time PCR , 2001, Journal of Clinical Microbiology.

[38]  M. D. de Jong,et al.  Quantitation of Varicella-Zoster Virus DNA in Whole Blood, Plasma, and Serum by PCR and Electrochemiluminescence , 2000, Journal of Clinical Microbiology.

[39]  K. Haspolat,et al.  Central Nervous System Tuberculosis in Children: A Review of 214 Cases , 1998, Pediatrics.

[40]  Denise A. Martin,et al.  Japanese encephalitis among hospitalized pediatric and adult patients with acute encephalitis syndrome in Hanoi, Vietnam 1995. , 1998, The American journal of tropical medicine and hygiene.

[41]  F. Queuche,et al.  [Endemic area of paragonimiasis in Vietnam]. , 1997, Sante.

[42]  A. Hightower,et al.  Bacterial meningitis in the United States, 1986: report of a multistate surveillance study. The Bacterial Meningitis Study Group. , 1990, The Journal of infectious diseases.

[43]  T. Bunnag,et al.  Eosinophilic meningitis in Thailand Clinical and epidemiological characteristics of 162 patients with myeloencephalitis probably caused by Gnathostoma spinigerum , 1990, Journal of the Neurological Sciences.

[44]  F. Harrell,et al.  Differential diagnosis of acute meningitis. An analysis of the predictive value of initial observations. , 1989, JAMA.

[45]  A. Gean,et al.  The spinal tap: a new look at an old test. , 1986, Annals of internal medicine.

[46]  R. Beck,et al.  Melioidosis and bilateral third‐nerve palsies , 1984, Neurology.

[47]  K. Nelson,et al.  Community-acquired purulent meningitis: a review of 1,316 cases during the antibiotic era, 1954-1976. , 1980, Reviews of infectious diseases.

[48]  W. Feldman.  Effect of prior antibiotic therapy on concentrations of bacteria in CSF. , 1978, American journal of diseases of children.

[49]  B. Greenwood,et al.  Pneumococcal meningitis: a clinical and laboratory study. , 1976, The Quarterly journal of medicine.

[50]  T. Bunnag,et al.  Eosinophilic meningitis in Thailand. Clinical studies of 484 typical cases probably caused by Angiostrongylus cantonensis. , 1975, The American journal of tropical medicine and hygiene.

[51]  H. Hill,et al.  Partial antibiotic therapy in Haemophilus infuenzae meningitis. Its effect on cerebrospinal fluid abnormalities. , 1975, American journal of diseases of children.

[52]  P. Trinh,et al.  [A case of eosinophilic meningoencephalitis, bronchopneumonia and interstitial myocarditis caused by Angiostrongylus cantonensis, Chen 1935]. , 1974, Bulletin de la Societe de pathologie exotique et de ses filiales.

[53]  J. Galicich,et al.  Formation and absorption of cerebrospinal fluid in man. , 1968, Brain : a journal of neurology.

[54]  Le-van-Hoa,et al.  [Gnathostoma and human gnathostomosis in Vietnam]. , 1965, Bulletin de la Societe de pathologie exotique et de ses filiales.

[55]  Feeley Ej,et al.  PLAGUE MENINGITIS IN AN AMERICAN SERVICEMAN. , 1965 .

[56]  J. Rankin.  Cerebral Vascular Accidents in Patients over the Age of 60: II. Prognosis , 1957, Scottish medical journal.

[57]  S. Stewart.  The Bacteriological Diagnosis of Tuberculous Meningitis , 1953, Journal of clinical pathology.

[58]  G. Pickering.  Lumbar puncture headache. , 1948, Brain : a journal of neurology.

[59]  A. Mert,et al.  Tuberculous meningitis in adults in Turkey: Epidemiology, diagnosis, clinic and laboratory , 2004, European Journal of Epidemiology.

[60]  A. Mateczun,et al.  Tuberculosis meningitis, Abbassia Fever Hospital-Naval Medical Research Unit No. 3-Cairo, Egypt, from 1976 to 1996. , 1998, The American journal of tropical medicine and hygiene.

[61]  F. van Knapen,et al.  Preliminary report of praziquantel treatment of cysticercosis patients in Vietnam. , 1989, Acta Leidensia.

[62]  F. vanKnapen,et al.  Preliminary report of praziquantel treatment of cysticercosis patients in Vietnam. , 1989 .

[63]  J. Roux,et al.  [An epidemic of meningococcal infection in Vietnam (southern provinces)]. , 1981, Bulletin of the World Health Organization.

[64]  G. Sangster,et al.  The effects of pre-admission antibiotics on the bacteriological diagnosis of pyogenic meningitis. , 1978, Scandinavian journal of infectious diseases.

[65]  J. Kříž,et al.  PLAGUE MENINGITIS IN AN AMERICAN SERVICEMAN. , 1965, JAMA.