title: The spectrum of central nervous system infections in an adult referral hospital in Hanoi, Vietnam.
abstract: OBJECTIVE
  To determine prospectively the causative pathogens of central nervous system (CNS) infections in patients admitted to a tertiary referral hospital in Hanoi, Vietnam.
  
  
  METHODS
  From May 2007 to December 2008, cerebrospinal fluid (CSF) samples from 352 adults with suspected meningitis or encephalitis underwent routine testing, staining (Gram, Ziehl-Nielsen, India ink), bacterial culture and polymerase chain reaction targeting Neisseria meningitidis, Streptococcus pneumoniae, S. suis, Haemophilus influenzae type b, Herpes simplex virus (HSV), Varicella Zoster virus (VZV), enterovirus, and 16S ribosomal RNA. Blood cultures and clinically indicated radiology were also performed. Patients were classified as having confirmed or suspected bacterial (BM), tuberculous (TBM), cryptococcal (CRM), eosinophilic (EOM) meningitis, aseptic encephalitis/meningitis (AEM), neurocysticercosis and others.
  
  
  RESULTS
  352 (male: 66%) patients were recruited: median age 34 years (range 13-85). 95/352 (27.3%) diagnoses were laboratory confirmed and one by cranial radiology: BM (n = 62), TBM (n = 9), AEM (n = 19), CRM (n = 5), and neurocysticercosis (n = 1, cranial radiology). S. suis predominated as the cause of BM [48/62 (77.4%)]; Listeria monocytogenese (n = 1), S. pasteurianus (n = 1) and N. meningitidis (n = 2) were infrequent. AEM viruses were: HSV (n = 12), VZV (n = 5) and enterovirus (n = 2). 5 patients had EOM. Of 262/352 (74.4%) patients with full clinical data, 209 (79.8%) were hospital referrals and 186 (71%) had been on antimicrobials. 21 (8%) patients died: TBM (15.2%), AEM (10%), and BM (2.8%).
  
  
  CONCLUSIONS
  Most infections lacked microbiological confirmation. S. suis was the most common cause of BM in this setting. Improved diagnostics are needed for meningoencephalitic syndromes to inform treatment and prevention strategies.
authors.affiliation: Oxford University Clinical Research Unit, Hanoi, Vietnam. bob@tropmedres.ac
authors.forename: Walter R
authors.initials: WR
authors.lastname: Taylor
authors.forename: Kinh
authors.initials: K
authors.lastname: Nguyen
authors.forename: Duc
authors.initials: D
authors.lastname: Nguyen
authors.forename: Huyen
authors.initials: H
authors.lastname: Nguyen
authors.forename: Peter
authors.initials: P
authors.lastname: Horby
authors.forename: Ha L
authors.initials: HL
authors.lastname: Nguyen
authors.forename: Trinh
authors.initials: T
authors.lastname: Lien
authors.forename: Giang
authors.initials: G
authors.lastname: Tran
authors.forename: Ninh
authors.initials: N
authors.lastname: Tran
authors.forename: Ha M
authors.initials: HM
authors.lastname: Nguyen
authors.forename: Thai
authors.initials: T
authors.lastname: Nguyen
authors.forename: Ha H
authors.initials: HH
authors.lastname: Nguyen
authors.forename: Thanh
authors.initials: T
authors.lastname: Nguyen
authors.forename: Giap
authors.initials: G
authors.lastname: Tran
authors.forename: Jeremy
authors.initials: J
authors.lastname: Farrar
authors.forename: Menno
authors.initials: M
authors.lastname: de Jong
authors.forename: Constance
authors.initials: C
authors.lastname: Schultsz
authors.forename: Huong
authors.initials: H
authors.lastname: Tran
authors.forename: Diep
authors.initials: D
authors.lastname: Nguyen
authors.forename: Bich
authors.initials: B
authors.lastname: Vu
authors.forename: Hoa
authors.initials: H
authors.lastname: Le
authors.forename: Trinh
authors.initials: T
authors.lastname: Dao
authors.forename: Trung
authors.initials: T
authors.lastname: Nguyen
authors.forename: Heiman
authors.initials: H
authors.lastname: Wertheim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002494:Central Nervous System Infections / Q000134:cerebrospinal fluid / Q000453:epidemiology* / Q000382:microbiology*; D004660:Encephalitis / Q000134:cerebrospinal fluid / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008581:Meningitis / Q000134:cerebrospinal fluid / Q000453:epidemiology* / Q000382:microbiology*; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods; D011446:Prospective Studies; D012017:Referral and Consultation; D017011:Streptococcus suis / Q000378:metabolism*; D016896:Treatment Outcome; D014744:Vietnam