Volume 25, Number 5—May 2019
Research
Management of Central Nervous System Infections, Vientiane, Laos, 2003–2011
, Mayfong Mayxay, Rattanaphone Phetsouvanh1, Sue J. Lee, Sayaphet Rattanavong, Manivanh Vongsouvath, Viengmon Davong, Vilada Chansamouth, Koukeo Phommasone, Catrin Moore, Sabine Dittrich, Olay Lattana, Joy Sirisouk, Phonelavanh Phoumin, Phonepasith Panyanivong, Amphonesavanh Sengduangphachanh, Bountoy Sibounheuang, Anisone Chanthongthip, Manivone Simmalavong, Davanh Sengdatka, Amphaivanh Seubsanith, Valy Keoluangkot, Prasith Phimmasone, Kongkham Sisout, Khamsai Detleuxay, Khonesavanh Luangxay, Inpanh Phouangsouvanh, Scott B. Craig, Suhella M. Tulsiani, Mary-Anne Burns, David A.B. Dance, Stuart D. Blacksell, Xavier de Lamballerie, and Paul N. Newton
Table 4
Characteristics of peripheral blood and cerebrospinal fluid at admission of patients with suspected central nervous system infection, by age group and etiology, Laos, January 2003–August 2011*
| Sample type and parameter | Age group |
Etiology |
||||||
|---|---|---|---|---|---|---|---|---|
| All, n = 1,065 | Children, n = 358 | Adults, n = 707 | Confirmed, n = 450 | None confirmed, n = 615 | Confirmed viral, n = 172 | Confirmed bacterial, n = 175 | ||
| Peripheral blood | ||||||||
| Elevated white cell count,† n = 952 | 449 (47.2) | 150 (47.9) | 299 (46.8) | 198 (49.0) | 251 (45.8) | 84 (53.9) | 84 (53.5) | |
| Low white cell count, n = 952 | 45 (4.7) | 22 (7.0) | 23 (3.6) | 22 (5.5) | 23 (4.2) | 6 (3.9) | 7 (4.5) | |
| Anemia, n = 948 | 355 (37.5) | 112 (35.7) | 243 (38.3) | 160 (39.8) | 195 (35.7) | 44 (28.2) | 68 (43.9) | |
| Thrombocytopenia, n = 649 | 55 (8.5) | 16 (6.8) | 39 (9.4) | 22 (7.8) | 33 (9.0) | 4 (3.5) | 12 (10.6) | |
| Elevated C-reactive protein, n = 868 | 547 (63.0) | 145 (51.6) | 402 (68.5) | 265 (69.2) | 282 (58.1) | 98 (64.9) | 114 (79.7) | |
| Hyperglycemia,† n = 991 | 237 (23.9) | 81 (25.8) | 156 (23.0) | 105 (24.5) | 132 (23.5) | 40 (24.0) | 53 (32.3) | |
| Severe hyperglycemia,† n = 991 | 72 (7.3) | 26 (8.3) | 46 (6.8) | 35 (8.2) | 37 (6.6) | 12 (7.2) | 22 (13.4) | |
| Elevated serum sodium,‡ n = 807 | 225 (27.9) | 45 (17.8) | 180 (32.5) | 82 (22.8) | 143 (31.9) | 40 (28.6) | 26 (19.4) | |
| Low serum sodium,‡ n = 807 |
63 (7.8) |
31 (12.3) |
32 (5.8) |
31 (8.6) |
32 (7.1) |
8 (5.7) |
16 (11.9) |
|
| Cerebrospinal fluid | ||||||||
| Turbid, n = 999 | 145 (14.5) | 40 (12.2) | 105 (15.7) | 80 (18.4) | 65 (11.5) | 21 (12.4) | 38 (23.2) | |
| Elevated opening pressure, n = 977 | 334 (34.2) | 86 (27.6) | 248 (37.3) | 155 (36.4) | 179 (32.5) | 42 (24.9) | 60 (37.3) | |
| Elevated white cell count,§ n = 975 | 729 (74.8) | 237 (74.8) | 492 (74.8) | 341 (80.2) | 388 (70.6) | 141 (84.9) | 129 (80.1) | |
| Elevated lymphocyte count, n = 890 | 467 (52.5) | 149 (51.2) | 318 (53.1) | 234 (59.5) | 233 (46.9) | 106 (68.4) | 91 (62.3) | |
| Elevated neutrophil count, n = 889 | 644 (72.4) | 213 (73.5) | 431 (72.0) | 309 (78.8) | 335 (67.4) | 130 (83.9) | 116 (80.0) | |
| Elevated eosinophil count,¶ n = 1,001 | 46 (4.6) | 7 (2.1) | 39 (5.8) | 11 (2.5) | 35 (6.2) | 9 (5.3) | 2 (1.2) | |
| Elevated protein, n = 955 | 601 (62.9) | 177 (57.3) | 424 (65.6) | 281 (66.9) | 320 (59.8) | 112 (66.3) | 108 (69.7) | |
| Decreased glucose, n = 957 | 280 (29.3) | 58 (18.8) | 222 (34.3) | 138 (32.8) | 142 (26.5) | 45 (26.6) | 51 (32.9) | |
| Decreased cerebrospinal fluid:venous glucose ratio, n = 929 | 540 (58.1) | 159 (54.8) | 381 (59.6) | 253 (61.7) | 287 (55.3) | 97 (58.8) | 97 (64.2) | |
| Elevated lactate, n = 985 | 650 (66.0) | 217 (67.8) | 433 (65.1) | 298 (69.8) | 352 (63.1) | 93 (56.0) | 132 (80.5) | |
*Values are no. (%). We defined children as patients <15 years of age and adults >15 years of age. The confirmed viral group includes patients infected with multiple viruses, and the confirmed bacterial group includes patients infected with multiple bacteria. Elevated and low parameters mean above or below reference ranges. Anemia is defined as hematocrit below reference range. Thrombocytopenia is defined as platelet count below reference range. See Appendix Table 3 for reference ranges. CSF, cerebrospinal fluid.
†Hyperglycemia was defined as a blood glucose level of >7.7 mmol/L and severe hyperglycemia as a blood glucose level >11.1 mmol/L.
‡Serum sodium levels >150 mmol/L were considered elevated and <130 mmol/L considered low; 5 patients (0.6%) had serum sodium <115 mmol/L.
§Samples with high turbidity could not be counted and were thus not included.
¶An eosinophil count >10% was considered elevated.
1Deceased.