A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017-2018
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. F...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
Springer Nature
2021
|
| _version_ | 1797084213215756288 |
|---|---|
| author | Saba Villarroel, PM Castro Soto, MDR Melendres Flores, O Peralta Landívar, A Calderón, ME Loayza, R Boucraut, J Thirion, L Dubot-Pérès, A Ninove, L de Lamballerie, X |
| author_facet | Saba Villarroel, PM Castro Soto, MDR Melendres Flores, O Peralta Landívar, A Calderón, ME Loayza, R Boucraut, J Thirion, L Dubot-Pérès, A Ninove, L de Lamballerie, X |
| author_sort | Saba Villarroel, PM |
| collection | OXFORD |
| description | 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 | 2024-03-07T01:52:15Z |
| format | Journal article |
| id | oxford-uuid:9a8434a8-24ea-4439-8889-a6511a8e4f94 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T01:52:15Z |
| publishDate | 2021 |
| publisher | Springer Nature |
| record_format | dspace |
| spelling | oxford-uuid:9a8434a8-24ea-4439-8889-a6511a8e4f942022-03-27T00:21:56ZA clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017-2018Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:9a8434a8-24ea-4439-8889-a6511a8e4f94EnglishSymplectic ElementsSpringer Nature2021Saba Villarroel, PMCastro Soto, MDRMelendres Flores, OPeralta Landívar, ACalderón, MELoayza, RBoucraut, JThirion, LDubot-Pérès, ANinove, Lde Lamballerie, XCentral 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. |
| spellingShingle | Saba Villarroel, PM Castro Soto, MDR Melendres Flores, O Peralta Landívar, A Calderón, ME Loayza, R Boucraut, J Thirion, L Dubot-Pérès, A Ninove, L de Lamballerie, X A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017-2018 |
| 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 |
| work_keys_str_mv | AT sabavillarroelpm aclinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT castrosotomdr aclinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT melendresfloreso aclinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT peraltalandivara aclinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT calderonme aclinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT loayzar aclinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT boucrautj aclinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT thirionl aclinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT dubotperesa aclinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT ninovel aclinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT delamballeriex aclinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT sabavillarroelpm clinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT castrosotomdr clinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT melendresfloreso clinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT peraltalandivara clinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT calderonme clinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT loayzar clinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT boucrautj clinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT thirionl clinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT dubotperesa clinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT ninovel clinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 AT delamballeriex clinicalaetiologicalandpublichealthperspectiveoncentralnervoussysteminfectionsinbolivia20172018 |