The challenge of treating central nervous system infections

Ranawaka, Udaya K.

doi:10.4038/cmj.v60i4.8178

Cited by 4 publications

(6 citation statements)

References 33 publications

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“…Moreover, integration of epidemiology research and availability of antimicrobial susceptibility patterns will invariably help clinicians to treat patients on time with targeted therapy. 22 Nevertheless, our health policy developers together with clinicians and biomedical researchers need to pay special attention to employ novel technology allowing better patient care. This would include the development of antimicrobial stewardship programs.…”

Section: Discussionmentioning

confidence: 99%

Childhood Central Nervous System Infections: Are We under Estimating the True Burden?

Jayaweera

Thalagahage²,

Joseph

et al. 2017

J Pediatr Infect Dis

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Children are more susceptible than adults to acquire central nervous system (CNS) infections. This study assesses the validity of routine cerebrospinal fluid (CSF) culture with the meningitis/encephalitis (ME) FilmArray to detect etiological agents in CNS infections. Based on CSF culture, only 5/40 samples were positive in suspected meningitis, whereas 24/40 samples were positive with the ME FilmArray (p?=?0.01). Sensitivity and specificity of conventional culture method were 55.81 and 100%. Overall disability adjusted life years in the study cohort was 1,603.5. Conventional culture with clinical suspicion alone is not enough to obtain an etiological diagnosis of meningitis. The implementation of novel diagnostic techniques is crucial.

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Section: Discussionmentioning

confidence: 99%

Childhood Central Nervous System Infections: Are We under Estimating the True Burden?

Jayaweera

Thalagahage²,

Joseph

et al. 2017

J Pediatr Infect Dis

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“…27 Meningitis can usually be excluded in the absence of at least one of these symptoms. 28 Other associated signs and symptoms are headache, vomiting and nausea, seizures, and rash. Other than these symptoms, classical signs of physical examinations to diagnose meningitis include Brudzinski's and Kernig's signs.…”

Section: Diagnosis Clinical Presentationmentioning

confidence: 99%

Epidemiology and diagnosis of viral and bacterial central nervous system infections in Sri Lanka: A Narrative review

Dheerasekara

Muthugala²,

Liyanapathirana

2023

Sri Lankan J Infec Dis

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Bacterial central nervous system (CNS) infections are life-threatening diseases with high mortality and long-term neurological sequels, while viral CNS infections are mild and selflimited. In Sri Lanka, 1000-1500 and 150-250 patients with meningitis and encephalitis respectively are reported annually to the Epidemiology Unit. Haemophilus influenzae, Group B Streptococcus, Streptococcus pneumoniae, Escherichia coli, Mycobacterium tuberculosis, Neisseria meningitidis, Group D Streptococcus, Leptospira borgpetersenii serovar Tarasssovi, Listeria monocytogenes, Streptococcus bovis biotype 2, enterovirus, Herpes Simplex Virus type 1 and type 2, Varicella zoster virus and cytomegalovirus have been reported up to 2022 in patients with meningitis while dengue virus, Japanese encephalitis virus, Varicella zoster virus, West Nile virus, Human Bocavirus Type 1, 2 and 3, human adenovirus type 41, Echovirus type 9 and 25, Herpes Simplex Virus type 1 and Mycoplasma pneumoniae have been reported in patients with encephalitis and meningoencephalitis. However less than 10% of cases have a definitive aetiological diagnosis with conventional bacterial culture methods routinely used to diagnose bacterial CNS infections, while molecular assays are used only for selected common viral pathogens in government hospitals in Sri Lanka. Use of antibiotics prior to cerebrospinal fluid collection, delay in sample collection, and low volume of samples have been identified as factors for low sensitivity of test results. Scientists, microbiologists and virologists are responsible for developing new test methods to identify current and previously unidentified causative microorganisms to extend the spectrum of neurotropic organisms in Sri Lanka to enhance the aetiological diagnosis.

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“…A closer analysis of the published literature reveals that reported high isolations rates can perhaps be misleading 54 . Most studies reporting high isolation rates are from case series with a defined syndrome (bacterial meningitis, viral encephalitis, etc.…”

Section: Study 1 Study 2 Study 2 Extension (Cnth Analysis) (Analysis mentioning

confidence: 99%

“…Data from unselected patients with clinically suspected CNS infection, as in our study, is limited [41][42][43][44]57,58 . Such data is more important for 'point of care' clinical decision making in the acute stage, as patients do not present with a label of 'bacterial meningitis' or 'viral encephalitis', but with a diagnostically challenging clinical syndrome of febrile meningo-encephalopathy (meningo-encephalitis) 54 . Similar studies with unselected patient recruitment based on a presumptive clinical diagnosis of CNS infection have reported much lower rates of isolation even from developed countries, similar to our findings [41][42][43][44][58][59][60] .…”

Section: Study 1 Study 2 Study 2 Extension (Cnth Analysis) (Analysis mentioning

confidence: 99%