A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017–2018
Abstract Central nervous system (CNS) infections are important causes of morbidity and mortality worldwide. In Bolivia, aetiologies, case fatality, and determinants of outcome are poorly characterised. We attempted to investigate such parameters to guide diagnosis, treatment, prevention, and health...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2021-12-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-021-02592-6 |
| _version_ | 1818460219413364736 |
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| author | Paola Mariela Saba Villarroel María del Rosario Castro Soto Oriana Melendres Flores Alejandro Peralta Landívar María E. Calderón Roxana Loayza José Boucraut Laurence Thirion Audrey Dubot-Pérès Laetitia Ninove Xavier de Lamballerie |
| author_facet | Paola Mariela Saba Villarroel María del Rosario Castro Soto Oriana Melendres Flores Alejandro Peralta Landívar María E. Calderón Roxana Loayza José Boucraut Laurence Thirion Audrey Dubot-Pérès Laetitia Ninove Xavier de Lamballerie |
| author_sort | Paola Mariela Saba Villarroel |
| collection | DOAJ |
| description | Abstract Central nervous system (CNS) infections are important causes of morbidity and mortality worldwide. In Bolivia, aetiologies, case fatality, and determinants of outcome are poorly characterised. We attempted to investigate such parameters to guide diagnosis, treatment, prevention, and health policy. From Nov-2017 to Oct-2018, we prospectively enrolled 257 inpatients (20.2% HIV-positive patients) of all ages from healthcare centers of Cochabamba and Santa Cruz, Bolivia with a suspected CNS infection and a lumbar puncture performed. Biological diagnosis included classical microbiology, molecular, serological and immunohistochemical tests. An infectious aetiology was confirmed in 128/257 (49.8%) inpatients, including, notably among confirmed single and co-infections, Cryptococcus spp. (41.7%) and Mycobacterium tuberculosis (27.8%) in HIV-positive patients, and Mycobacterium tuberculosis (26.1%) and Streptococcus pneumoniae (18.5%) in HIV-negative patients. The total mortality rate was high (94/223, 42.1%), including six rabies cases. In multivariate logistic regression analysis, mortality was associated with thrombocytopenia (Odds ratio (OR) 5.40, 95%-CI 2.40–11.83) and hydrocephalus (OR 4.07, 95%-CI 1.35–12.23). The proportion of untreated HIV patients, late presentations of neurotuberculosis, the rate of pneumococcal cases, and rabies patients who did not benefit from a post-exposure prophylaxis, suggest that decreasing the burden of CNS infections requires reinforcing health policy regarding tuberculosis, rabies, S. pneumoniae vaccination, and HIV-infections. |
| first_indexed | 2024-12-14T23:26:46Z |
| format | Article |
| id | doaj.art-877ca9d5e7994111bb73338edc6f7fda |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-12-14T23:26:46Z |
| publishDate | 2021-12-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-877ca9d5e7994111bb73338edc6f7fda2022-12-21T22:43:46ZengNature PortfolioScientific Reports2045-23222021-12-0111111110.1038/s41598-021-02592-6A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017–2018Paola Mariela Saba Villarroel0María del Rosario Castro Soto1Oriana Melendres Flores2Alejandro Peralta Landívar3María E. Calderón4Roxana Loayza5José Boucraut6Laurence Thirion7Audrey Dubot-Pérès8Laetitia Ninove9Xavier de Lamballerie10Unité des Virus Émergents (UVE: Aix-Marseille Univ.-IRD 190-INSERM 1207-IHU Méditerranée Infection)Infectology Department, Viedma HospitalNeurology Department, Dr. Mario Ortíz Suárez HospitalNeurology Department, Japonés HospitalInfectology Department, Manuel Ascencio Villarroel HospitalMolecular Biology Unit, Centro Nacional de Enfermedades Tropicales (CENETROP)Immunology Laboratory, Conception HospitalUnité des Virus Émergents (UVE: Aix-Marseille Univ.-IRD 190-INSERM 1207-IHU Méditerranée Infection)Unité des Virus Émergents (UVE: Aix-Marseille Univ.-IRD 190-INSERM 1207-IHU Méditerranée Infection)Unité des Virus Émergents (UVE: Aix-Marseille Univ.-IRD 190-INSERM 1207-IHU Méditerranée Infection)Unité des Virus Émergents (UVE: Aix-Marseille Univ.-IRD 190-INSERM 1207-IHU Méditerranée Infection)Abstract Central nervous system (CNS) infections are important causes of morbidity and mortality worldwide. In Bolivia, aetiologies, case fatality, and determinants of outcome are poorly characterised. We attempted to investigate such parameters to guide diagnosis, treatment, prevention, and health policy. From Nov-2017 to Oct-2018, we prospectively enrolled 257 inpatients (20.2% HIV-positive patients) of all ages from healthcare centers of Cochabamba and Santa Cruz, Bolivia with a suspected CNS infection and a lumbar puncture performed. Biological diagnosis included classical microbiology, molecular, serological and immunohistochemical tests. An infectious aetiology was confirmed in 128/257 (49.8%) inpatients, including, notably among confirmed single and co-infections, Cryptococcus spp. (41.7%) and Mycobacterium tuberculosis (27.8%) in HIV-positive patients, and Mycobacterium tuberculosis (26.1%) and Streptococcus pneumoniae (18.5%) in HIV-negative patients. The total mortality rate was high (94/223, 42.1%), including six rabies cases. In multivariate logistic regression analysis, mortality was associated with thrombocytopenia (Odds ratio (OR) 5.40, 95%-CI 2.40–11.83) and hydrocephalus (OR 4.07, 95%-CI 1.35–12.23). The proportion of untreated HIV patients, late presentations of neurotuberculosis, the rate of pneumococcal cases, and rabies patients who did not benefit from a post-exposure prophylaxis, suggest that decreasing the burden of CNS infections requires reinforcing health policy regarding tuberculosis, rabies, S. pneumoniae vaccination, and HIV-infections.https://doi.org/10.1038/s41598-021-02592-6 |
| spellingShingle | Paola Mariela Saba Villarroel María del Rosario Castro Soto Oriana Melendres Flores Alejandro Peralta Landívar María E. Calderón Roxana Loayza José Boucraut Laurence Thirion Audrey Dubot-Pérès Laetitia Ninove Xavier de Lamballerie A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017–2018 Scientific Reports |
| title | A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017–2018 |
| title_full | A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017–2018 |
| title_fullStr | A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017–2018 |
| title_full_unstemmed | A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017–2018 |
| title_short | A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017–2018 |
| title_sort | clinical aetiological and public health perspective on central nervous system infections in bolivia 2017 2018 |
| url | https://doi.org/10.1038/s41598-021-02592-6 |
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