Gabor Julian Justin, Anh Chu Xuan, Sy Bui Tien, Hoan Phan Quoc, Quyen Dao Thanh, The Nguyen Trong, Kuk Salih, Kremsner Peter G, Meyer Christian G, Song Le Huu, Velavan Thirumalaisamy P
Institute of Tropical Medicine, University of Tübingen, Wilhelmstrasse 27, 72074, Tübingen, Germany.
Vietnamese - German Centre for Medical Research (VG-CARE), Hanoi, Vietnam.
Sci Rep. 2022 Oct 27;12(1):18065. doi: 10.1038/s41598-022-23007-0.
Knowledge of the clinical presentation of central nervous system (CNS) infections and the causative pathogens is crucial for appropriate diagnosis and rapid initiation of appropriate treatment to prevent severe neurological sequelae. The aim of this study is to understand the aetiology of CNS infections based on the clinical presentation of Vietnamese patients. A prospective hospital-based cohort study was conducted between May 2014 and May 2017. We screened 137 patients with clinically suspected CNS infection for fungal, bacterial and viral pathogens using their cerebrospinal fluid (CSF) and blood cultures. In addition, DNA or RNA extracted from CSF samples were subjected to nucleic acid testing (NAT) with a selective panel of bacterial, viral and fungal pathogens. At least one pathogen could be detected in 41% (n = 56) of the patients. The main pathogens causing CNS infections were Streptococcus suis (n = 16; 12%) and Neisseria meningitidis (n = 9; 7%), followed by Herpes simplex virus 1/2 (n = 4; 3%) and Klebsiella pneumoniae (n = 4; 3%). Other pathogens were only identified in a few cases. Patients with bacterial CNS infections were significantly older, had a worse outcome, a lower Glasgow Coma Scale (GCS), a higher rate of speech impairment and neck stiffness than patients with viral or tuberculous CNS infections. In northern Vietnam, adults are mostly affected by bacterial CNS infections, which have a severe clinical course and worse outcomes compared to viral or tuberculous CNS infections. Clinicians should be aware of the regional occurrence of pathogens to initiate rapid and appropriate diagnosis and treatment.
了解中枢神经系统（CNS）感染的临床表现及致病病原体对于做出恰当诊断并迅速开始适当治疗以预防严重神经后遗症至关重要。本研究的目的是根据越南患者的临床表现了解CNS感染的病因。2014年5月至2017年5月期间进行了一项基于医院的前瞻性队列研究。我们使用脑脊液（CSF）和血培养对137例临床怀疑有CNS感染的患者进行真菌、细菌和病毒病原体筛查。此外，从CSF样本中提取的DNA或RNA用一组选择性的细菌、病毒和真菌病原体进行核酸检测（NAT）。41%（n = 56）的患者中至少可检测到一种病原体。引起CNS感染的主要病原体是猪链球菌（n = 16；12%）和脑膜炎奈瑟菌（n = 9；7%），其次是单纯疱疹病毒1/2型（n = 4；3%）和肺炎克雷伯菌（n = 4；3%）。其他病原体仅在少数病例中被鉴定出来。与病毒或结核性CNS感染患者相比，细菌性CNS感染患者年龄显著更大，预后更差，格拉斯哥昏迷量表（GCS）评分更低，言语障碍和颈部僵硬发生率更高。在越南北部，成年人大多受到细菌性CNS感染影响，与病毒或结核性CNS感染相比，其临床病程严重且预后更差。临床医生应了解病原体的地区分布情况，以便迅速做出恰当诊断和治疗。
