PATU12 Acute central nervous system infections in adults—a retrospective cohort study in the NHS northwest region

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 81; no. 11; p. e27
• Main Authors: Michael, B, Beeching, N J, Sidhu, M, Roberts, M, Bonington, A, Hart, I J, Kneen, R, Miller, A, Solomon, T, Stoeter, D
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01-11-2010; BMJ Publishing Group LTD
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.2010.226340.41

BackgroundOver the last 15 years bacterial meningitis has received considerable attention; viral central nervous system (CNS) infections have been relatively neglected. Aim: Examine the relative incidence, clinical features and management of suspected adult CNS infections across the Region.MethodsMulticentre (10 hospitals) cross-sectional retrospective cohort study over 3 months. All patients with cerebrospinal fluid analysis or acyclovir and/or third-generation cephalosporin; those with clinical features suspicious of a CNS infection were included. Management was compared with the national meningitis and regional encephalitis guidelines.Results385 patients were screened; 217 had a suspected CNS infection; 44 (20%) had a CNS infection: 18 aseptic meningitis (one herpes simplex virus (HSV)-2), 13 purulent meningitis (four Streptococcus pneumoniae), and 13 encephalitis (3 HSV-1). The median (range) time from admission to suspicion of CNS infection and to LP was longer for patients with encephalitis than meningitis (4 (0.3–312) vs 0.3 (0.1–12) h, p<0.001, and 23 (4–360) vs 12 (2–48) h, p=0.042, respectively); and median time to treatment was longer for acyclovir than cephalosporin (7 (0.5–312) vs 3 (0.3–312) h, p=0.002).ConclusionsEncephalitis was as common as purulent meningitis, and HSV as common as S pneumoniae. However, the management of patients with encephalitis was worse than meningitis. National encephalitis guidelines are needed.