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Acute central nervous system infections in adults-a retrospective cohort study in the NHS North West Region

Michael, BD, Sidhu, M, Stoeter, D, Roberts, M, Beeching, Nicholas ORCID: https://orcid.org/0000-0002-7019-8791, Bonington, A, Hart, IJ, Kneen, R, Miller, A and Solomon, T (2010) 'Acute central nervous system infections in adults-a retrospective cohort study in the NHS North West Region'. Quarterly Journal of Medicine, Vol 103, Issue 10, pp. 749-758.

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Abstract

Background: Over the last 15 years, bacterial meningitis has received considerable attention, including national guidelines, whilst viral central nervous system (CNS) infections have been relatively neglected. A recent pilot study suggested that management of patients with suspected viral encephalitis was often suboptimal.
Aim: To examine the relative incidence, clinical features and management of suspected acute CNS infections in adults across the NHS North West Region.
Design: A multicentre cross-sectional retrospective cohort study at 10 hospitals across the region over 3 months (from September to December 2007). Following a screen of all patients who had cerebrospinal fluid (CSF) analysis or received intravenous aciclovir 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.
Results: Three hundred and eighty-five patients were screened; 217 patients had a suspected CNS infection and 44 (20%) had a CNS infection: 18 aseptic meningitis (one herpes simplex virus [HSV]-2), 13 purulent meningitis (four Streptococcus pneumoniae) and 13 encephalitis (three 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 the median time to treatment was longer for aciclovir than cephalosporin [7 (0.5–312) vs. 3 (0.3–312) h, P = 0.002].
Discussion: Encephalitis was as common as purulent meningitis, and HSV as common as Streptococcus

Item Type: Article
Subjects: WL Nervous System > WL 140 Nervous system diseases (General)
Faculty: Department: Groups (2002 - 2012) > Clinical Group
Digital Object Identifer (DOI): https://doi.org/10.1093/qjmed/hcq121
Depositing User: Users 43 not found.
Date Deposited: 15 Oct 2010 14:21
Last Modified: 06 Feb 2018 13:01
URI: https://archive.lstmed.ac.uk/id/eprint/1430

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