Lee Heng Gee, William Timothy, Menon Jayaram, Ralph Anna P, Ooi Eng Eong, Hou Yan'an, Sessions October, Yeo Tsin Wen
Department of Medicine, The Infectious Disease Unit, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.
Jesselton Medical Centre, Kota Kinabalu, Sabah, Malaysia.
BMC Infect Dis. 2016 Jun 16;16:296. doi: 10.1186/s12879-016-1640-x.
Central nervous system (CNS) infections are a significant contributor to morbidity and mortality globally. However, most published studies have been conducted in developed countries where the epidemiology and aetiology differ significantly from less developed areas. Additionally, there may be regional differences due to variation in the socio-economic levels, public health services and vaccination policies. Currently, no prospective studies have been conducted in Sabah, East Malaysia to define the epidemiology and aetiology of CNS infections. A better understanding of these is essential for the development of local guidelines for diagnosis and management.
We conducted a prospective observational cohort study in patients aged 12 years and older with suspected central nervous system infections at Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia between February 2012 and March 2013. Cerebrospinal fluid was sent for microscopy, biochemistry, bacterial and mycobacterial cultures, Mycobacterium tuberculosis polymerase chain reaction (PCR), and multiplex and MassCode PCR for various viral and bacterial pathogens.
A total of 84 patients with clinically suspected meningitis and encephalitis were enrolled. An aetiological agent was confirmed in 37/84 (44 %) of the patients. The most common diagnoses were tuberculous meningitis (TBM) (41/84, 48.8 %) and cryptococcal meningoencephalitis (14/84, 16.6 %). Mycobacterium tuberculosis was confirmed in 13/41 (31.7 %) clinically diagnosed TBM patients by cerebrospinal fluid PCR or culture. The acute case fatality rate during hospital admission was 16/84 (19 %) in all patients, 4/43 (9 %) in non-TBM, and 12/41 (29 %) in TBM patients respectively (p = 0.02).
TBM is the most common cause of CNS infection in patients aged 12 years or older in Kota Kinabalu, Sabah, Malaysia and is associated with high mortality and morbidity. Further studies are required to improve the management and outcome of TBM.
中枢神经系统（CNS）感染是全球发病和死亡的重要原因。然而，大多数已发表的研究是在发达国家进行的，这些国家的流行病学和病因学与欠发达地区有显著差异。此外，由于社会经济水平、公共卫生服务和疫苗接种政策的差异，可能存在地区差异。目前，马来西亚东部沙巴州尚未开展前瞻性研究来确定中枢神经系统感染的流行病学和病因学。更好地了解这些情况对于制定当地的诊断和管理指南至关重要。
2012年2月至2013年3月期间，我们在马来西亚沙巴州哥打基纳巴卢市伊丽莎白女王医院对12岁及以上疑似中枢神经系统感染的患者进行了一项前瞻性观察队列研究。采集脑脊液进行显微镜检查、生化分析、细菌和分枝杆菌培养、结核分枝杆菌聚合酶链反应（PCR），以及针对各种病毒和细菌病原体的多重PCR和MassCode PCR检测。
共纳入84例临床疑似脑膜炎和脑炎的患者。37/84（44%）的患者确诊了病原体。最常见的诊断是结核性脑膜炎（TBM）（41/84，48.8%）和隐球菌性脑膜脑炎（14/84，16.6%）。通过脑脊液PCR或培养，在13/41（31.7%）临床诊断为TBM的患者中确诊了结核分枝杆菌。所有患者住院期间的急性病死率为16/84（19%），非TBM患者为4/43（9%），TBM患者为12/41（29%）（p = 0.02）。
在马来西亚沙巴州哥打基纳巴卢市，TBM是12岁及以上患者中枢神经系统感染的最常见原因，且与高死亡率和高发病率相关。需要进一步研究以改善TBM的管理和治疗效果。
