Central nervous system (CNS) infections result in significant morbidity and are of public health importance. Understanding the etiology is necessary for prevention and management of these infections. Information on these is limited in Singapore, therefore we aim to describe the epidemiology, clinical features and etiology of CNS infections amongst the adult population in Singapore to compare and contrast with other countries.
Patients with suspected CNS infections were prospectively enrolled into the study. They were managed as per routine clinical practice. Data such as demographics, clinical and microbiological information were collected.
We recruited 193 patients with clinically suspected CNS infections from August 2013 to March 2016. Amongst these, 155 patients had CNS pathology with 63.9% male and 36.1% female. The median age was 49 years (Range: 18-88). Majority were Chinese (110; 71.0%), followed by Malay (18; 11.6%), Indian (12; 7.7%), and others (15; 9.7). Fever (111; 71.6%), headache (96; 61.9%), nausea or vomiting (72; 46.5%) and altered mental status (68; 43.9%) were common. Out of 155, 94 (60.6%) had identifiable etiology while 61 (39.4%) remained unknown. Of those with identifiable etiology, 87 (56.1%) cases were infective. Amongst the bacterial pathogens (44; 50.6%), Group B Streptococcus (16; 18.4%) and Treponema pallidum (9; 10.3%) were the most common. Herpes Simplex virus (6; 6.9%) and Varicella Zostervirus (6; 6.9%) were the most common identified viral pathogens (20; 23.0%). There were 17 (19.5%) cases of presumptive tuberculosis. Autoimmune was established in 7 (7.4%) cases. There is no related death due to CNS infections during the study period.
This is the first prospective hospital-based observation study on CNS infections in Singapore. Whilst the confirmed viral etiologies were expected, we see a sizeable number with Group B Streptococcus CNS infections as well as a burden of tuberculosis CNS infections. The etiology of more than one-third of cases remains elusive, indicating that the identification of CNS etiologies with current clinical diagnostics remains a considerable challenge.
L. Wijaya, None