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Volume 25, Number 5—May 2019
Research

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 5

Frequency of criteria consistent with bacterial meningitis among patients with suspected central nervous system infection, by etiology and antibiotic susceptibility, Laos, January 2003–August 2011*

Variables Patients with confirmed etiology, n = 450
Patients without confirmed etiology, 
n = 615 Total, 
n = 1,065
All Patients infected by bacteria treatable by†
Other, 
n = 305
Ceftriaxone
Doxycycline
Not including Leptospira infections, 
n = 56‡ Including Leptospira infections, n = 84 Not including Leptospira infections, 
n = 64§ Including Leptospira infections, n = 90
Neck stiffness¶ 316 (70.2) 41 (73.2) 60 (71.4) 46 (71.9) 63 (70.0) 213 (69.8) 367 (59.8) 683 (64.2)
GCS score <15 225 (50.5) 34 (61.8) 47 (56.6) 27 (42.2) 40 (44.4) 152 (50.3) 326 (54.2) 551 (52.6)
Elevated CRP 265 (69.2) 44 (91.7) 60 (87.0) 36 (70.6) 51 (72.9) 171 (64.3) 282 (58.1) 547 (63.0)
CSF turbid 80 (18.4) 27 (49.1) 31 (37.8) 6 (10.7) 9 (11.1) 45 (15.1) 65 (11.5) 145 (14.5)
Elevated CSF lactate 298 (69.8) 44 (83.0) 63 (78.8) 44 (74.6) 62 (73.8) 193 (66.3) 352 (63.1) 650 (66.0)
Elevated CSF protein 281 (66.9) 44 (81.5) 57 (73.1) 32 (62.7) 43 (58.9) 195 (66.3) 320 (59.8) 601 (62.9)
Decreased CSF glucose 138 (32.8) 23 (42.6) 26 (33.3) 12 (23.5) 15 (20.5) 101 (34.2) 142 (26.5) 280 (29.3)
Decreased CSF:venous glucose ratio 253 (61.7) 40 (76.9) 49 (64.5) 27 (54) 35 (48.6) 179 (62.4) 287 (55.3) 540 (58.1)
Elevated CSF leukocyte count#
341 (80.2)
44 (86.3)
64 (82.1)

39 (69.6)
57 (70.4)
241 (82.0)
388 (70.6)
729 (74.8)
Combinations of >1 of the above findings
Elevated CSF lactate,
protein, leukocyte 
count; decreased CSF 
glucose; CSF turbid# 418 (95.9) 53 (96.4) 76 (93.8) 54 (90.0) 75 (89.3) 291 (97.7) 534 (93.2) 952 (94.4)
Elevated CRP; 
elevated CSF lactate, 
protein; CSF turbid 427 (96.4) 56 (100) 82 (100) 59 (92.2) 83 (94.3) 289 (96.3) 526 (93.4) 953 (94.7)
Elevated CRP; 
elevated CSF lactate, 
protein 425 (95.4) 56 (100) 82 (100) 58 (92.1) 82 (94.3) 288 (96.3) 525 (93.4) 950 (94.7)
Elevated CRP; 
elevated CSF lactate 385 (91.2) 54 (98.2) 78 (98.7) 56 (91.8) 78 (94.0) 254 (89.1) 478 (88.5) 863 (89.7)
Elevated CRP; 
elevated CSF protein 382 (90.1) 54 (98.2) 75 (94.9) 49 (89.1) 68 (88.3) 261 (89.1) 442 (84.2) 824 (86.8)
Elevated CRP; GCS
score <15 348 (83.9) 50 (100.0) 72 (98.6) 49 (86.0) 70 (89.7) 229 (79.5) 448 (83.1) 796 (83.4)
GCS score <15; 
elevated CSF protein 348 (81.1) 49 (90.7) 68 (85.0) 44 (77.2) 61 (75.3) 239 (81.0) 454 (80.8) 802 (80.9)
GCS score <15; 
elevated CSF lactate 361 (84.1) 48 (88.9) 69 (85.2) 50 (83.3) 70 (82.4) 244 (83.8) 466 (80.3) 827 (82.0)
GCS score <15; 
elevated CSF lactate, 
protein 404 (92.9) 52 (94.5) 75 (91.5) 53 (88.3) 74 (87.1) 279 (94.3) 515 (89.4) 919 (90.9)

*All values are no. (%). See Appendix Table 3 for reference ranges. Only patients with confirmed etiology strictly sensitive to ceftriaxone or doxycycline are included in the analysis. Classification was based on a combination of susceptibility testing of isolates from patients and information from Principles and Practice of Infectious Diseases (43). Patients who were confused or disoriented who had their GCS score missing were considered to have a GCS score <15. CRP, C-reactive protein; CSP, cerebrospinal fluid; GCS, Glasgow Coma Scale.
†In total, 28 patients were infected with Leptospira spp. treatable by either ceftriaxone or doxycycline, but 2 were also co-infected with Orientia tsutsugamushi not treatable with ceftriaxone. One patient co-infected with Streptococcus suis and Rickettsis typhi required therapy with both ceftriaxone and doxycycline.
‡Includes 24 patients infected with Streptococcus pneumoniae and 32 infected with other bacteria (7 Escherichia coli, 4 Group B Streptococcus, 4 Neisseria meningitidis, 1 Salmonella enterica group D, 1 S. enterica group B or C, 5 S. suis, 5 S. enterica serovar Typhi, 2 Klebsiella pneumoniae, 2 Haemophilus influenzae, and 1 Edwardsiella tarda).
§Includes 31 patients with Rickettsia spp. infection and 33 with O. tsutsugamushi infection.
¶History of neck stiffness or neck stiffness on examination.
#Samples with high turbidity could not be counted and were thus not included.

Main Article

1Deceased.

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