Presentation, etiology, and outcome of brain infections in an Indonesian hospital A cohort study

Imran, Darma and Estiasari, Riwanti and Maharani, Kartika and Sucipto, and Lestari, Delly Chipta and Yunus, Reyhan Eddy and Yunihastuti, Evy and Karyadi, Teguh Haryono and Oei, Diana and Timan, Ina S. and Wulandari, Dewi and Wahyuningsih, Retno and Adawiyah, Robiatul and Kurniawan, Agnes and Mulyadi, Rahmad and Karuniawati, Anis and Jaya, Ungke Anton and Safari, Dodi and Laarhoven, Arjan van and Alisjahbana, Bachti and Dian, Sofiati and Chaidir, Lidya and Ganiem, Ahmad Rizal and Lastri, Diatri Nari and Myint, Khin Saw Aye and Crevel, Reinout van (2018) Presentation, etiology, and outcome of brain infections in an Indonesian hospital A cohort study. Neurology: Clinical Practice, 8 (5).

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Abstract

Background Little detailed knowledge is available regarding the etiology and outcome of CNS infection, particularly in HIV-infected individuals, in low-resource settings. Methods From January 2015 to April 2016, we prospectively included all adults with suspected CNS infection in a referral hospital in Jakarta, Indonesia. Systematic screening included HIV testing, CSF examination, and neuroimaging. Results A total of 274 patients with suspected CNS infection (median age 26 years) presented after a median of 14 days with headache (77%), fever (78%), seizures (27%), or loss of consciousness (71%). HIV coinfection was common (54%), mostly newly diagnosed (30%) and advanced (median CD4 cell count 30/μL). Diagnosis was established in 167 participants (65%), including definite tuberculous meningitis (TBM) (n = 44), probable TBM (n = 48), cerebral toxoplasmosis (n = 48), cryptococcal meningitis (n = 14), herpes simplex virus/varicella-zoster virus/ cytomegalovirus encephalitis (n = 10), cerebral lymphoma (n = 1), neurosyphilis (n = 1), and mucormycosis (n = 1). In-hospital mortality was 32%; 6-month mortality was 57%. The remaining survivors had either moderate or severe disability (36%) according to Glasgow Outcome Scale. Conclusion In this setting, patients with CNS infections present late with severe disease and often associated with advanced HIV infection. Tuberculosis, toxoplasmosis, and cryptococcosis are common. High mortality and long-term morbidity underline the need for service improvements and further study.

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