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PATU12 Acute central nervous system infections in adults—a retrospective cohort study in the NHS northwest region
  1. B Michael,
  2. N J Beeching,
  3. M Sidhu,
  4. M Roberts,
  5. A Bonington,
  6. I J Hart,
  7. R Kneen,
  8. A Miller,
  9. T Solomon,
  10. D Stoeter
  1. 1Liverpool Brain Infections Group, Tropical and Infectious Disease Unit, Liverpool Specialist Virology Centre, Royal Liverpool University Hospital, Liverpool, UK
  2. 2Lancashire Hospitals NHS Trust, North Manchester General Hospital, Salford Royal NHS Foundation Trust, Manchester, UK
  3. 3Alder Hey Children's Hospital NHS Trust, Liverpool, UK
  1. Correspondence to benedictmichael{at}doctors.net.uk

Abstract

Background Over 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.

Methods Multicentre (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.

Results 385 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).

Conclusions Encephalitis 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.

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