title: A Population-Based Acute Meningitis and Encephalitis Syndromes Surveillance in Guangxi, China, May 2007-June 2012.
abstract: OBJECTIVE
  Acute meningitis and encephalitis (AME) are common diseases with the main pathogens being viruses and bacteria. As specific treatments are different, it is important to develop clinical prediction rules to distinguish aseptic from bacterial or fungal infection. In this study we evaluated the incidence rates, seasonal variety and the main etiologic agents of AME, and identified factors that could be used to predict the etiologic agents.
  
  
  METHODS
  A population-based AME syndrome surveillance system was set up in Guigang City, Guangxi, involving 12 hospitals serving the study communities. All patients meeting the case definition were investigated. Blood and/or cerebrospinal fluid were tested for bacterial pathogens using culture or RT-PCR and serological tests for viruses using enzyme-linked immunosorbent assays. Laboratory testing variables were grouped using factor analysis. Multinomial logistic regression was used to predict the etiology of AME.
  
  
  RESULTS
  From May 2007 to June 2012, the annual incidence rate of AME syndrome, and disease specifically caused by Japanese encephalitis (JE), other viruses, bacteria and fungi were 12.55, 0.58, 4.57, 0.45 and 0.14 per 100,000 population, respectively. The top three identified viral etiologic agents were enterovirus, mumps virus, and JE virus, and for bacteria/fungi were Streptococcus sp., Cryptococcus neoformans and Staphylococcus sp. The incidence of JE and other viruses affected younger populations and peaked from April to August. Alteration of consciousness and leukocytosis were more likely to be caused by JE, bacteria and fungi whereas CSF inflammation was associated with bacterial/fungal infection.
  
  
  CONCLUSIONS
  With limited predictive validity of symptoms and signs and routine laboratory tests, specific tests for JE virus, mumps virus and enteroviruses are required to evaluate the immunization impact and plan for further intervention. CSF bacterial culture cannot be omitted in guiding clinical decisions regarding patient treatment.
authors.affiliation: Acute Infectious Disease Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.
authors.forename: Yihong
authors.initials: Y
authors.lastname: Xie
authors.affiliation: Acute Infectious Disease Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Tan
authors.affiliation: Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, HatYai, Songkla, Thailand.
authors.forename: Virasakdi
authors.initials: V
authors.lastname: Chongsuvivatwong
authors.affiliation: Acute Infectious Disease Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.
authors.forename: Xinghua
authors.initials: X
authors.lastname: Wu
authors.affiliation: Acute Infectious Disease Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.
authors.forename: Fuyin
authors.initials: F
authors.lastname: Bi
authors.affiliation: Division of Bacterial Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Hadler
authors.affiliation: International Field Epidemiology Training Program (IFETP), Bureau of Epidemiology, Ministry of Public Health, Bangkok, Thailand.
authors.forename: Chuleeporn
authors.initials: C
authors.lastname: Jiraphongsa
authors.affiliation: Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, HatYai, Songkla, Thailand.
authors.forename: Vorasith
authors.initials: V
authors.lastname: Sornsrivichai
authors.affiliation: Acute Infectious Disease Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Lin
authors.affiliation: Acute Infectious Disease Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Quan
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D004660:Encephalitis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008581:Meningitis / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D011159:Population Surveillance; D055815:Young Adult