A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017–2018

Abstract 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...

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Autores principales:	Paola Mariela Saba Villarroel, María del Rosario Castro Soto, Oriana Melendres Flores, Alejandro Peralta Landívar, María E. Calderón, Roxana Loayza, José Boucraut, Laurence Thirion, Audrey Dubot-Pérès, Laetitia Ninove, Xavier de Lamballerie
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/877ca9d5e7994111bb73338edc6f7fda
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spelling	oai:doaj.org-article:877ca9d5e7994111bb73338edc6f7fda2021-12-05T12:16:06ZA clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017–201810.1038/s41598-021-02592-62045-2322https://doaj.org/article/877ca9d5e7994111bb73338edc6f7fda2021-12-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-02592-6https://doaj.org/toc/2045-2322Abstract 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.Paola Mariela Saba VillarroelMaría del Rosario Castro SotoOriana Melendres FloresAlejandro Peralta LandívarMaría E. CalderónRoxana LoayzaJosé BoucrautLaurence ThirionAudrey Dubot-PérèsLaetitia NinoveXavier de LamballerieNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Paola Mariela Saba Villarroel María del Rosario Castro Soto Oriana Melendres Flores Alejandro Peralta Landívar María E. Calderón Roxana Loayza José Boucraut Laurence Thirion Audrey Dubot-Pérès Laetitia Ninove Xavier de Lamballerie A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017–2018
description	Abstract 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.
format	article
author	Paola Mariela Saba Villarroel María del Rosario Castro Soto Oriana Melendres Flores Alejandro Peralta Landívar María E. Calderón Roxana Loayza José Boucraut Laurence Thirion Audrey Dubot-Pérès Laetitia Ninove Xavier de Lamballerie
author_facet	Paola Mariela Saba Villarroel María del Rosario Castro Soto Oriana Melendres Flores Alejandro Peralta Landívar María E. Calderón Roxana Loayza José Boucraut Laurence Thirion Audrey Dubot-Pérès Laetitia Ninove Xavier de Lamballerie
author_sort	Paola Mariela Saba Villarroel
title	A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017–2018
title_short	A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017–2018
title_full	A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017–2018
title_fullStr	A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017–2018
title_full_unstemmed	A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017–2018
title_sort	clinical, aetiological, and public health perspective on central nervous system infections in bolivia, 2017–2018
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/877ca9d5e7994111bb73338edc6f7fda
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A clinical, aetiological, and public health perspective on central nervous system infections in Bolivia, 2017–2018

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