Volume 25, Number 5—May 2019
Research
Management of Central Nervous System Infections, Vientiane, Laos, 2003–2011
, 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
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.
1Deceased.