title: Clinical profile and difficulties in diagnosis of central nervous system infections in adult patients in a tertiary care hospital.
abstract: OBJECTIVE
  We aimed to describe the pattern of central nervous system (CNS) infections and accuracy of diagnosis in a Sri Lankan tertiary care hospital.
  
  
  METHODS
  We prospectively studied all adult patients with suspected CNS infection admitted over a two-year period. Data were collected on demographic and clinical features, laboratory findings, treatment and immediate outcome. Diagnosis of CNS infection was categorized as definite, probable, possible and uncertain.
  
  
  RESULTS
  We studied 215 patients [59.1% males; mean age (SD) 44 (20) years]. Blood cultures were done in 65 (30.2%) and only one was positive. Lumbar puncture was done in 146 (67.9%), and cerebrospinal fluid Gram stains, culture and acid-fast bacilli stains were all negative. Diagnosis of CNS infection was considered 'definite' in only one patient, 'probable' in 57.2%, 'possible' in 5.6%, and 'uncertain' in 26%. An alternative diagnosis was found in 23 patients (10.7%). Intravenous antibiotics and aciclovir were given on emperical grounds, largely without microbiological confirmation.
  
  
  CONCLUSIONS
  Diagnosis of CNS infections is highly unsatisfactory with available facilities, even in a tertiary care setting.
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Kelaniya, Sri Lanka. udayaran@yahoo.com
authors.forename: U K
authors.initials: UK
authors.lastname: Ranawaka
authors.forename: E G D S
authors.initials: EG
authors.lastname: Rajindrajith
authors.forename: K V H K K
authors.initials: KV
authors.lastname: Perera
authors.forename: K M M P
authors.initials: KM
authors.lastname: Dassanayake
authors.forename: B A H R
authors.initials: BA
authors.lastname: Premaratne
authors.forename: H J
authors.initials: HJ
authors.lastname: de Silva
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002494:Central Nervous System Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D002648:Child; D004569:Electroencephalography; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013188:Sri Lanka; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed; D055815:Young Adult