Tuberculous meningitis is a major cause of mortality and morbidity in adults with central nervous system infections in Kota Kinabalu, Sabah, Malaysia: an observational study.
Central nervous system (CNS) infections are a significant contributor to morbidity and mortality globally. However, most published studies have been conducted in developed countries where the epidemiology and aetiology differ significantly from less developed areas. Additionally, there may be regional differences due to variation in the socio-economic levels, public health services and vaccination policies. Currently, no prospective studies have been conducted in Sabah, East Malaysia to define the epidemiology and aetiology of CNS infections. A better understanding of these is essential for the development of local guidelines for diagnosis and management.



We conducted a prospective observational cohort study in patients aged 12 years and older with suspected central nervous system infections at Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia between February 2012 and March 2013. Cerebrospinal fluid was sent for microscopy, biochemistry, bacterial and mycobacterial cultures, Mycobacterium tuberculosis polymerase chain reaction (PCR), and multiplex and MassCode PCR for various viral and bacterial pathogens.



A total of 84 patients with clinically suspected meningitis and encephalitis were enrolled. An aetiological agent was confirmed in 37/84 (44 %) of the patients. The most common diagnoses were tuberculous meningitis (TBM) (41/84, 48.8 %) and cryptococcal meningoencephalitis (14/84, 16.6 %). Mycobacterium tuberculosis was confirmed in 13/41 (31.7 %) clinically diagnosed TBM patients by cerebrospinal fluid PCR or culture. The acute case fatality rate during hospital admission was 16/84 (19 %) in all patients, 4/43 (9 %) in non-TBM, and 12/41 (29 %) in TBM patients respectively (p = 0.02).



TBM is the most common cause of CNS infection in patients aged 12 years or older in Kota Kinabalu, Sabah, Malaysia and is associated with high mortality and morbidity. Further studies are required to improve the management and outcome of TBM.
Department of Medicine, The Infectious Disease Unit, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.
Heng Gee
HG
Lee
Department of Medicine, The Infectious Disease Unit, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.|Jesselton Medical Centre, Kota Kinabalu, Sabah, Malaysia.
Timothy
T
William
Department of Medicine, The Infectious Disease Unit, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.
Jayaram
J
Menon
Menzies School of Health Research, Darwin, Australia.
Anna P
AP
Ralph
Program in Emerging Infectious Diseases, Duke-NUS Graduate Medical School, Singapore, Singapore.
Eng Eong
EE
Ooi
Program in Emerging Infectious Diseases, Duke-NUS Graduate Medical School, Singapore, Singapore.
Yan'an
Y
Hou
Program in Emerging Infectious Diseases, Duke-NUS Graduate Medical School, Singapore, Singapore.
October
O
Sessions
Menzies School of Health Research, Darwin, Australia. yeotsinwen@ntu.edu.sg.|Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. yeotsinwen@ntu.edu.sg.|Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore. yeotsinwen@ntu.edu.sg.
Tsin Wen
TW
Yeo
D000293:Adolescent; D000328:Adult; D000368:Aged; D002494:Central Nervous System Infections / Q000134:cerebrospinal fluid / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D015331:Cohort Studies; D003455:Cryptococcus neoformans / Q000235:genetics / Q000302:isolation & purification; D046508:Culture Techniques; D005260:Female; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D016919:Meningitis, Cryptococcal / Q000134:cerebrospinal fluid / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D008590:Meningoencephalitis / Q000134:cerebrospinal fluid / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D014390:Tuberculosis, Meningeal / Q000134:cerebrospinal fluid / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D055815:Young Adult
Central nervous system infections; Encephalitis; Meningitis; Meningo-encephalitis; Tuberculous meningitis