Management of Central Nervous System Infections, Vientiane, Laos, 2003-2011
Management of Central Nervous System Infections, Vientiane, Laos, 2003-2011
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DOI：
10.3201/eid2505.180914
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发表时间：
2019-05-01
影响因子：
11.8
通讯作者：
Newton, Paul N.
中科院分区：
文献类型：
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作者：
Dubot-Peres, Audrey;Mayxay, Mayfong;Newton, Paul N.
2003-2011年间，我们招募了1065名所有年龄段的疑似中枢神经系统(CNS)感染患者住进毛霍索医院(老挝万象)。42.3%的患者的病因得到了实验室确认，他们大多感染了新出现的病原体：病毒占16.2%(主要是日本脑炎病毒[8.8%])；细菌占16.4%(包括东方体[2.9%]、钩端螺旋体)。[2.3%]和立克次体。[2.3%])和隐球菌属。真菌占6.6%。我们观察到临床脑炎和脑膜炎在细菌或病毒病原学上的分布没有显著差异。然而，患有细菌性中枢神经系统感染的患者比其他患者更有可能有糖尿病病史。死亡(26.3%)与低格拉斯哥昏迷评分相关，细菌感染患者的死亡率高于病毒感染患者。没有临床或实验室变量可以指导抗生素的选择。我们的结论是，高度依赖单位和头孢曲松和多西环素对疑似中枢神经系统感染的一线治疗可以提高老挝患者的存活率。
During 2003-2011, we recruited 1,065 patients of all ages admitted to Mahosot Hospital (Vientiane, Laos) with suspected central nervous system (CNS) infection. Etiologies were laboratory confirmed for 42.3% of patients, who mostly had infections with emerging pathogens: viruses in 16.2% (mainly Japanese encephalitis virus [8.8%]); bacteria in 16.4% (including Orientia tsutsugamushi [2.9%], Leptospira spp. [2.3%], and Rickettsia spp. [2.3%]); and Cryptococcus spp. fungi in 6.6%. We observed no significant differences in distribution of clinical encephalitis and meningitis by bacterial or viral etiology. However, patients with bacterial CNS infection were more likely to have a history of diabetes than others. Death (26.3%) was associated with low Glasgow Coma Scale score, and the mortality rate was higher for patients with bacterial than viral infections. No clinical or laboratory variables could guide antibiotic selection. We conclude that high-dependency units and first-line treatment with ceftriaxone and doxycycline for suspected CNS infections could improve patient survival in Laos.