Matthews Elizabeth, Diaz-Arias Luisa A, Beekmann Susan E, Polgreen Philip, Waldrop Greer, Yang Vivian, Rimmer Kathryn, Venkatesan Arun, Thakur Kiran T
Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA.
Johns Hopkins Encephalitis Center, Division of Neuroimmunology and Neuroinfectious Diseases, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Open Forum Infect Dis. 2020 May 9;7(6):ofaa163. doi: 10.1093/ofid/ofaa163. eCollection 2020 Jun.
To monitor emerging infectious diseases, the Centers for Disease Control and Prevention and the Infectious Disease Society of America established the Emerging Infections Network (EIN), allowing infectious disease specialists to post inquiries about clinical cases. We describe the frequency and characteristics of neuroinfectious disease-related inquiries.
The EIN listserv was retrospectively reviewed from February 1997 to December 2019 using search terms associated with neurologic diseases. We recorded case summaries, disease type (ie, meningitis, encephalitis), inquiry type (diagnostic approach, result interpretation, management decisions), unique patient populations, exposures, pathogens, ultimate diagnosis, and change in clinical care based on responses.
Of 2348 total inquiries, 285 (12.1%) related to neuroinfectious diseases. The majority involved meningitis (99, 34.7%) or encephalitis (56, 19.6%). One hundred fifteen inquiries (40%) related to management, 34 (12%) related to diagnostic workup, and 22 (8%) related to result interpretation. Eight (2.8%) specifically involved results of cerebrospinal fluid polymerase chain reaction testing. Sixty-three (22.1%) involved immunosuppressed patients (29 human immunodeficiency virus-positive cases [46%]). The most common pathogens were (19, 6.7%) and (18, 6.3%). In 74 (25%) inquiries, patients had neurologic symptoms without a clear infection, 38 (51.3%) of which included noninfectious neurologic etiologies in the differential diagnosis.
This study demonstrates the significant challenges of diagnosis and management of neuroinfectious diseases within the field of infectious diseases. It also highlights the importance of curated forums to guide the approach of difficult cases, in particular instances that mimic infectious diseases. Finally, the EIN listserv may assist in identifying areas for research and training to address these complexities.
为监测新发传染病，美国疾病控制与预防中心和美国传染病学会建立了新发感染网络（EIN），允许传染病专家发布有关临床病例的询问。我们描述了与神经感染性疾病相关询问的频率和特征。
使用与神经系统疾病相关的搜索词，对1997年2月至2019年12月的EIN邮件列表进行回顾性审查。我们记录了病例摘要、疾病类型（即脑膜炎、脑炎）、询问类型（诊断方法、结果解读、管理决策）、独特的患者群体、暴露情况、病原体、最终诊断以及基于回复的临床护理变化。
在总共2348次询问中，285次（12.1%）与神经感染性疾病有关。大多数涉及脑膜炎（99次，34.7%）或脑炎（56次，19.6%）。115次询问（40%）与管理有关，34次（12%）与诊断检查有关，22次（8%）与结果解读有关。8次（2.8%）特别涉及脑脊液聚合酶链反应检测结果。63次（22.1%）涉及免疫抑制患者（29例人类免疫缺陷病毒阳性病例[46%]）。最常见的病原体是[具体病原体1]（19次，6.7%）和[具体病原体2]（18次，6.3%）。在74次（25%）询问中，患者有神经系统症状但无明确感染，其中38次（51.3%）在鉴别诊断中包括非感染性神经系统病因。
本研究表明了传染病领域中神经感染性疾病诊断和管理的重大挑战。它还强调了精心策划的论坛对于指导疑难病例处理方法的重要性，特别是对于模仿传染病的情况。最后，EIN邮件列表可能有助于确定研究和培训领域，以应对这些复杂性。
