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Volume 25, Number 5—May 2019

Management of Central Nervous System Infections, Vientiane, Laos, 2003–2011

Audrey Dubot-PérèsComments to Author , Mayfong Mayxay, Rattanaphone Phetsouvanh1, Sue J. Lee, Sayaphet Rattanavong, Manivanh Vongsouvath, Viengmon Davong, Vilada Chansamouth, Koukeo Phommasone, Catrin Moore, Sabine Dittrich, Olay Lattana, Joy Sirisouk, Phonelavanh Phoumin, Phonepasith Panyanivong, Amphonesavanh Sengduangphachanh, Bountoy Sibounheuang, Anisone Chanthongthip, Manivone Simmalavong, Davanh Sengdatka, Amphaivanh Seubsanith, Valy Keoluangkot, Prasith Phimmasone, Kongkham Sisout, Khamsai Detleuxay, Khonesavanh Luangxay, Inpanh Phouangsouvanh, Scott B. Craig, Suhella M. Tulsiani, Mary-Anne Burns, David A.B. Dance, Stuart D. Blacksell, Xavier de Lamballerie, and Paul N. Newton
Author affiliations: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Laos (A. Dubot-Pérès, M. Mayxay, R. Phetsouvanh, S. Rattanavong, M. Vongsouvath, V. Davong, V. Chansamouth, K. Phommasone, C. Moore, S. Dittrich, O. Lattana, J. Sirisouk, P. Phoumin, P. Panyanivong, A. Sengduangphachanh, B. Sibounheuang, A. Chanthongthip, M. Simmalavong, D. Sengdatka, A. Seubsanith, D.A.B. Dance, P.N. Newton); University of Oxford Nuffield Department of Clinical Medicine Center for Tropical Medicine and Global Health, Oxford, UK (A. Dubot-Pérès, S.J. Lee, C. Moore, S. Dittrich, D.A.B. Dance, S.D. Blacksell, P.N. Newton); Unité des Virus Émergents (UVE: Aix-Marseille Univ-IRD 190-INSERM 1207-IHU Méditerranée Infection), Marseille, France (A. Dubot-Pérès, X. de Lamballerie); University of Health Sciences Institute of Research and Education Development, Vientiane (M. Mayxay); Mahidol University Faculty of Tropical Medicine Mahidol– Oxford Tropical Medicine Research Unit, Bangkok, Thailand (S.J. Lee, S.D. Blacksell); Mahosot Hospital, Vientiane (V. Keoluangkot, P. Phimmasone, K. Sisout, K. Detleuxay, K. Luangxay, I. Phouangsouvanh); Queensland Health Forensic and Scientific Service World Health Organization Collaborating Centre for Reference and Research on Leptospirosis, Brisbane, Queensland, Australia (S.B. Craig, S.M. Tulsiani, M.-A. Burns); London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK (D.A.B. Dance, P.N. Newton)

Main Article

Table 3

Demographic and clinical data at admission of patients with suspected CNS infection, by age group and etiology, Laos, January 2003–August 2011*

Characteristic Etiology
Age group
Confirmed, n = 450 None confirmed, n = 615 Confirmed viral, 
n = 172 Confirmed bacterial, 
n = 175
n = 1,065 Children, 
n = 358 Adults, 
n = 707
M 666 (62.5) 207 (57.8) 459 (64.9) 288 (64.0) 378 (61.5) 111 (64.5) 117 (66.9)
F 399 (37.5) 151 (42.2) 248 (35.1) 162 (36.0) 237 (38.5) 61 (35.5) 58 (33.1)
Age, y, median (IQR)
23 (8–38)
3 (0.41–8)
32 (24–47)

23 (10–38)
24 (6–40)
16 (7–28)
23 (9–45)
HIV seropositive, n = 703 119 (16.9) 1 (0.4) 118 (24.8) 75 (27.1) 44 (10.33) 8 (8.0) 6 (6.2)
Diabetes, n = 850 24 (2.8) 0 24 (4.2) 12 (3.5) 12 (2.4) 1 (0.8) 10 (7.5)
Antibiotic use before lumbar 
puncture, n = 953
590 (61.9)
238 (71.9)
352 (56.6)

252 (64.0)
338 (60.5)
109 (69.9)
100 (62.5)
Signs and symptoms
Days of fever at admission, 
median (IQR), n = 1,058 4 (2–8) 4 (2–6) 5 (2–10) 5 (3–10) 4 (1–7) 5 (3–7) 5 (3–8)
Fever, n = 1,059 962 (90.8) 340 (95.2) 622 (88.6) 425 (94.9) 537 (87.9) 162 (95.3) 171 (97.7)
Headache,† n = 893 787 (88.1) 155 (83.3) 632 (89.4) 369 (92.5) 418 (84.6) 139 (90.9) 135 (91.2)
Hearing loss,† n = 893 51 (5.7) 10 (5.4) 41 (5.8) 20 (5.0) 31 (6.3) 8 (5.2) 7 (4.7)
Dysuria,† n = 891 28 (3.1) 4 (2.2) 24 (3.4) 10 (2.5) 18 (3.7) 3 (2.0) 3 (2.0)
Visual loss,† n = 885 66 (7.5) 14 (7.7) 52 (7.4) 23 (5.8) 43 (8.8) 11 (7.2) 5 (3.4)
Diplopia,† n = 889 36 (4.1) 4 (2.2) 32 (4.5) 15 (3.4) 21 (4.3) 6 (4.0) 6 (4.1)
Photophobia, n = 850 52 (5.8) 14 (7.4) 38 (5.4) 23 (5.8) 29 (5.9) 7 (4.6) 10 (6.8)
Focal neurologic signs, n = 939 22‡ (2.3) 5 (1.6) 17 (2.7) 8 (2.1) 14 (2.5) 1 (0.7) 6 (4.1)
Neck stiffness, n = 1,064 683 (64.2) 245 (68.4) 438 (62.0) 316 (70.2) 367 (59.8) 130 (75.6) 128 (73.1)
Confusion, n = 1,060 608 (57.4) 232 (65.5) 376 (53.3) 254 (56.7) 354 (57.8) 114 (66.3) 103 (59.5)
Convulsions, n = 1,063 319 (30.0) 233 (65.3) 86 (12.2) 119 (26.5) 200 (32.6) 65 (37.8) 44 (25.3)
GCS score, median (IQR), n = 1,010 14 (11–15) 14 (10–15) 15 (11–15) 15 (11–15) 14 (10–15) 13 (10–15) 14 (11–15)
GCS score <15,§ n = 1,047 551 (52.6) 220 (63.4) 331 (47.3) 225 (50.5) 326 (54.2) 101 (59.4) 94 (54.0)
WHO clinical CNS infection,¶ 
n = 1,040
771 (74.1)
313 (90.7)
458 (65.9)

341 (77.0)
430 (72.0)
143 (85.1)
140 (80.9)
Days of hospitalization, n = 846, 
median (IQR) 9 (5–14) 8 (5–13) 10 (5–15.5) 11 (6–17) 8 (5–13) 10 (6–14) 11 (7–17)
Death,# n = 893 235 (26.3) 70 (22.5) 165 (28.4) 94 (25.0) 141 (27.3) 23 (15.7) 43 (27.9)

*Values are no. (%) unless indicated otherwise. We defined children as patients <15 years of age and adults >15 years of age. History or physical examination or both, were taken into account for confusion, neck stiffness, photophobia, fever (history of fever or >37.5ºC during physical examination). In total, 8 women in the patient population were pregnant; 26 (2.4%) patients had computed tomography brain scans, and 2 of these scans demonstrated brain abscesses. The confirmed viral group includes patients infected with multiple viruses, and the confirmed bacterial group includes patients infected with multiple bacteria. CNS, central nervous system; GCS, Glasgow Coma Scale; IQR, interquartile range; WHO, World Health Organization.
†Data from children <3 years of age were considered not reliable and were thus excluded from analysis.
‡Of these patients, 7 had hemiplegia, 11 had limb weakness, and 1 had paraplegia; 13 patients had admission or discharge diagnoses of Guillain-Barre syndrome. Retrospective evaluation of the likelihood of this diagnosis by using the Brighton system suggested that 4 patients met level 3 criteria for Guillain-Barre syndrome diagnostic certainty (42).
§Includes confused and disoriented patients.
¶Defined as fever with GCS score <15, neck stiffness (history of or present during examination), or history of seizures or any of these signs in combination. Patients with missing data for 1 of these criteria were not counted.
#Includes patients who died at the hospital and those taken home to die.

Main Article

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