Title : Clinical profile and outcomes of central nervous system infections: a single centre hospital-based study
Abstract:
Background Central nervous system (CNS) infections, such as meningitis and encephalitis, caused by various pathogens, can lead to serious morbidity and mortality, with diverse symptoms and outcomes. Survivors may face long-term neurological complications, making early treatment crucial.
Objectives The study aimed to investigate the clinical presentation, in-hospital outcomes, predictors of clinical outcomes, the relationship between initial clinical status and treatment outcomes during hospitalization, and the 3-month post- discharge motor and cognitive outcomes in patients with central nervous system infections.
Material and methods This quantitative longitudinal observational study was conducted in the Department of Neurology at Tribhuvan University Teaching Hospital (TUTH) over the course of one year, from July 2022 to July 2023, in a patient aged 18 years or more, diagnosed with central nervous system (CNS) infections. Motor and cognitive functions were assessed at discharge and again 90 days post-discharge using standardized tools, including the Modified Rankin Scale and Mini-Mental State Examination.
Results In a study involving 149 patients aged 18-87 with CNS) infections, the mean age was 46.50 years, with male to female ratio 1:0.49. Viral meningoencephalitis (43%) and CNS tuberculosis (27.5%) were the most common infections. Hypertension (17.45%), diabetes mellitus (12.08%), and HIV (9.40%) were the most common comorbidities. The most reported symptoms were altered sensorium (69.8%), fever (64.4%), and headache (63.8%). Acute kidney injury (20.8%), hospital-associated pneumonia (17.4%) and seizures (16.2%) were the most common in-hospital complications. The mortality rate at discharge was 8.7%, increasing to 16.1% three months post-discharge, with significant differences among CNS infections. Multivariate analysis identified predictors for poor motor outcomes (age ≥50 years, tachycardia, longer hospital/ICU stay, CVA), and for poor cognitive outcomes (age ≥50 years, high opening pressure) at discharge. Only tachycardia predicted poor motor outcomes at 3 months post-discharge. No predictors were found for poor cognitive outcomes at this stage.
Conclusion In our setting, viral meningoencephalitis and CNS TB are the most common causes of CNS infections. However, there has been an increasing incidence of scrub typhus, dengue, non-classical bacterial pathogens, and fungal infections, which may indicate a significant change in the epidemiology of community-acquired CNS infections. CNS infections are serious and life-threatening conditions with a high case fatality rate. However, pathogen-directed treatment has shown significant improvement in in-hospital and 3-month post-discharge motor and cognitive outcomes.
