Novel highly sensitive diagnostic assays are in need for TBM. tuberculosis from CSF this conventional method is slow and insensitive to aid clinician to decide on time. TBM is diagnosed by culture and isolation of M. Many studies have shown that delays in diagnosis, which leads to delayed treatment, are a major contributing factor of high mortality of TBM. TBM requires specific anti-TB drugs for a longer period than conventional bacterial meningitis, and discrimination of TBM from bacterial meningitis by clinical features alone is difficult and often impossible. Moreover, a relatively high frequency of tubercular meningitis (TBM) is attributed to the complexity of CNS infection in developing countries, including Vietnam. The low proportion of confirmed diagnoses can be because of previous antibiotic use, natural clearance of virus, limited number of pathogens targeted in molecular assays, late lumbar puncture, and low sensitivity of diagnostic assays. However, 50–75% of the cases did not have a confirmed etiological diagnosis. Few studies have investigated the etiologies of CNS infection and showed that Streptococcus suis and Herpes simplex virus are the main bacterial (24–50%) and viral (3.5–4%) causes of meningoencephalitis syndrome. In Vietnam, mortality and morbidity due to CNS infections are high case fatality rate was 8–12% (21 deaths out of 262 in a study and 73 deaths out of 617 in another study), and residual disability was reported in 10–30% of survived patients. The incidence and etiology of CNS infection vary with time, geographical area, age of patients, underlying diseases, and vaccination status of the population. The CNS infection in the tropical climates is complex because a wide range of pathogens can cause it, including arboviruses, mycobacterium, fungi, protozoa, and helminths, besides pathogens commonly seen in developed countries. This biomarker might be helpful to diagnose tubercular meningitis once bacterial meningitis is ruled out by other methods.Ĭentral nervous system (CNS) infection is ten times more common in developing countries than in developed countries, where clinical diagnosis and empiric treatment without etiological confirmation is the main way of management. Raised CSF ADA (≥10 IU/L) was strongly associated with bacterial and tubercular meningitis. ConclusionsĪddition of molecular method to the conventional culture had enhanced the identification of etiologies of CNS infection. Rural residence (aOR 4.1, 95% CI 1.2–14.4) and raised CSF ADA (≥10 IU/L) (aOR 25.5, 95% CI 3.1–212) were associated with bacterial meningitis when compared with viral meningitis similarly, raised CSF ADA (≥10 IU/L) (aOR 42.2, 95% CI 2.0–882) was associated with tubercular meningitis. Mixed pathogens were detected in 1.8% of the CSF samples. pneumoniae (2.7%) were common bacterial and HSV (2.2%), Echovirus 6 (0.7%), and Echovirus 30 (0.7%) were common viral pathogens detected. Among 408 CSF samples tested by PCR, out of them, 358 were also tested by culture an etiology was identified in 27.5% ( n=112).
Five hundred eighty-three patients had abnormal CSF findings (meningoencephalitis) median age was 45 (IQR 31–58), 62.6% were male, and 60.9% were tested for HIV infection. Total number of patients admitted to the department was 7506 among them, 679 were suspected to have CNS infection, and they underwent lumbar puncture. In addition to culture, CSF samples were tested for common bacterial and viral pathogens by polymerase chain reaction (PCR) and for biomarkers: C-reactive protein and adenosine deaminase (ADA). All patients who were ≥ 16 years old and who had meningoencephalitis suggested by abnormal cerebrospinal fluid (CSF) findings (CSF total cell >5/mm3 or CSF protein ≥40 mg/dL) were included in the study. We conducted a cross-sectional study in the Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam, from June 2012 to May 2014.
The objectives of this study were to determine the causes of meningitis in adult patients by using molecular assays, to assess the risk factors associated with them, and to explore whether biomarkers can differentiate tubercular meningitis from bacterial meningitis. Tubercular meningitis is one of the common causes of meningitis, which has high morbidity and mortality, but lacks sensitive diagnostic assays. Laboratory facilities for etiological diagnosis of central nervous system (CNS) infection are limited in developing countries therefore, patients are treated empirically, and the epidemiology of the pathogens is not well-known.
0 kommentar(er)
