Clinical profile and difficulties in diagnosis of central nervous system infections in adult patients in a tertiary care hospital.

OBJECTIVES: 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.