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A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017–2018
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A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017–2018
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Journal Article
A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017–2018
2021
Overview
Central nervous system (CNS) infections are important causes of morbidity and mortality worldwide. In Bolivia, aetiologies, case fatality, and determinants of outcome are poorly characterised. We attempted to investigate such parameters to guide diagnosis, treatment, prevention, and health policy. From Nov-2017 to Oct-2018, we prospectively enrolled 257 inpatients (20.2% HIV-positive patients) of all ages from healthcare centers of Cochabamba and Santa Cruz, Bolivia with a suspected CNS infection and a lumbar puncture performed. Biological diagnosis included classical microbiology, molecular, serological and immunohistochemical tests. An infectious aetiology was confirmed in 128/257 (49.8%) inpatients, including, notably among confirmed single and co-infections,
Cryptococcus
spp. (41.7%) and
Mycobacterium tuberculosis
(27.8%) in HIV-positive patients, and
Mycobacterium tuberculosis
(26.1%) and
Streptococcus pneumoniae
(18.5%) in HIV-negative patients. The total mortality rate was high (94/223, 42.1%), including six rabies cases. In multivariate logistic regression analysis, mortality was associated with thrombocytopenia (Odds ratio (OR) 5.40, 95%-CI 2.40–11.83) and hydrocephalus (OR 4.07, 95%-CI 1.35–12.23). The proportion of untreated HIV patients, late presentations of neurotuberculosis, the rate of pneumococcal cases, and rabies patients who did not benefit from a post-exposure prophylaxis, suggest that decreasing the burden of CNS infections requires reinforcing health policy regarding tuberculosis, rabies,
S. pneumoniae
vaccination, and HIV-infections.
Publisher
Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
Subject
/ Central Nervous System Infections - epidemiology
/ Central Nervous System Infections - etiology
/ Central Nervous System Infections - microbiology
/ Cerebrospinal Fluid - microbiology
/ Cryptococcosis - epidemiology
/ Female
/ HIV
/ HIV Infections - complications
/ HIV Infections - epidemiology
/ Human immunodeficiency virus
/ Humanities and Social Sciences
/ Humans
/ Male
/ Patients
/ Pneumococcal Infections - epidemiology
/ Rabies
/ Science
