Table 1.
Clinical and demographic data of patients with suspected CNS infections by pathogen group
|
All patients (n=1112) |
Conventional bacteria (n=42) |
Rickettsia typhi or Rickettsia spp (n=28) |
Orientia tsutsugamushi (n=31) |
Leptospira spp (n=31) |
||||
|---|---|---|---|---|---|---|---|---|
| p value | p value | p value | ||||||
| Demographic data | ||||||||
| Age (years) | 24 (0–85; 1) | 14 (0·1–65) | 29 (0·3–70) | 0·051 | 16 (0·3–76) | 0·412 | 25 (0·2–72) | 0·058 |
| Age <15 years | 371/1111 (33%) | 21/42 (50%) | 7/28 (25%) | 0·048 | 14/31 (45%) | 0·813 | 7/31 (23%) | 0·028 |
| Male | 696/1111 (63%) | 26/ 42 (62%) | 18/28 (67%) | 1 | 22/31 (71%) | 0·464 | 22/31 (71%) | 0·464 |
| Farmers (if aged >15 years) | 110/614 (18%) | 6/18 (33%) | 2/18 (11%) | 0·228 | 2/13 (15%) | 0·412 | 6/19 (32%) | 1 |
| Preadmission antibiotic use | 619/992 (62%) | 23/36 (64%) | 17/25 (68%) | 0·790 | 25/29 (86%) | 0·051 | 17/29 (59%) | 0·798 |
| Symptoms and signs | ||||||||
| Fever at admission (>38°C) | 990/1102 (90%) | 41/42 (98%) | 27/27 (100%) | 1 | 31/31 (100%) | 1 | 30/31 (97%) | 1 |
| Days of fever | 4 (0–210; 10) | 3 (0-30) | 4 (1–30; 1) | 0·053 | 7 (1–15; 1) | 0·0001 | 4 (0–120) | 0·144 |
| Headache* | 820/932 (88%) | 21/25 (84%) | 24/25 (96%) | 0·349 | 24/27 (89%) | 0·698 | 28/29 (97%) | 0·170 |
| Vomiting | 523/1110 (47%) | 21/42 (50%) | 12/28 (15%) | 0·629 | 18/30 (60%) | 0·475 | 16/31 (52%) | 1 |
| Convulsions | 334/1108 (30%) | 18/41 (44%) | 7/28 (25%) | 0·132 | 8/31 (26%) | 0·141 | 6/31 (19%) | 0·043 |
| Stiff neck | 608/1107 (55%) | 29/42 (69%) | 14/28 (50%) | 0·136 | 20/30 (67%) | 1 | 15/31 (48%) | 0·093 |
| Skin rash | 117/1107 (11%) | 1/42 (2%) | 3/28 (11%) | 0·294 | 6/30 (20%) | 0·018 | 2/31 (7%) | 0·571 |
| Hearing loss* | 51/931 (6%) | 1/25 (4%) | 0/25 (0%) | 1 | 3/27 (11%) | 0·611 | 2/29 (7%) | 1 |
| Photophobia* | 29/982 (3%) | 1/41 (2%) | 0/28 (0%) | 1 | 4/30 (13%) | 0·155 | 1/31 (3·2) | 1 |
| Eschar | 21/1105 (2%) | 0/42 (0%) | 1/28 (4%) | 0·400 | 2/30 (7%) | 0·170 | 0/31 (0%) | 1 |
| Tachypnoea† | 585/1081 (54%) | 25/42 (60%) | 20/28 (71%) | 0·445 | 20/31 (65%) | 0·808 | 21/31 (68%) | 0·624 |
| Peripheral neurological abnormalities | 23/970 (2%) | 0/41 (0%) | 0/26 (0%) | 1 | 0/22 (0) | 1 | 3/27 (11%) | 0·058 |
| GCS | 14 (3–15; 61) | 13 (3-15; 3) | 14 (5-15; 1) | 0·442 | 15 (3–15; 1) | 0·013 | 15 (5–15) | 0·274 |
| GCS <15 | 531/1051 (51%) | 26/39 (67%) | 14/27 (52%) | 0·306 | 11/30 (37%) | 0·016 | 15/31 (48%) | 0·148 |
| Meningitis‡ | 709/1093 (65%) | 33/42 (79%) | 19/28 (68%) | 0·405 | 25/31 (81%) | 1 | 21/31 (68%) | 0·419 |
| Meningitis (>38·5°C) | 403/959 (42%) | 25/38 (66%) | 7/25 (28%) | 0·005 | 19/28 (68%) | 1 | 14/29 (48%) | 0·212 |
| Acute encephalitis syndrome‡ | 610/1093 (56%) | 33/42 (79%) | 16/28 (57%) | 0·067 | 15/31 (48%) | 0·012 | 16/31 (52%) | 0·023 |
| Meningitis and acute encephalitis syndrome‡ | 521/1093 (48%) | 29/42 (69%) | 16/28 (57%) | 0·322 | 14/31 (45%) | 0·055 | 14/31 (45%) | 0·055 |
| Died‡ | 236/876 (27%) | 13/39 (33%) | 7/26 (27%) | 0·784 | 3/22 (14%) | 0·132 | 3/23 (13%) | 0·132 |
| CSF data | ||||||||
| Opening pressure (cm H2O)§ | 20 (0–41; 120) | 24 (7·8–41; 5) | 17 (9-40) | 0·162 | 22 (8–41; 5) | 0·610 | 19 (10–35·5; 2) | 0·458 |
| Turbid | 145/1000 (15%) | 21/40 (53%) | 1/25 (4%) | <0·0001 | 4/25 (16·0) | 0·004 | 3/30 (10%) | <0·0001 |
| Total white cell count (mm3) | 30 (0–17 200; 104) | 410 (0–9600) | 10 (0–605; 2) | 0·0001 | 68 (0–653; 5) | 0·0001 | 88 (0–5325; 1) | 0·002 |
| Neutrophils (mm3) | 14·8 (0–17 200; 126) | 240 (0–9600) | 5·1 (0–545; 2) | 0·0001 | 44·8 (0–535; 6) | 0·0004 | 30 (0–4805; 1) | 0·0004 |
| Number of neutrophils ≥1/mm3 | 731/986 (74·1) | 39/42 (93%) | 17/28 (61%) | 0·003 | 22/25 (88%) | 0·664 | 23/30 (77%) | 0·019 |
| Lymphocytes (mm3) | 10 (0–6976; 134) | 25 (0–3515) | 5 (0–340; 2) | 0·005 | 21 (0–445; 6) | 0·236 | 21·8 (0–833; 1) | 0·352 |
| Number of lymphocytes >5/mm3 | 558/978 (57·1) | 32/42 (76%) | 10/26 (39%) | 0·004 | 18/25 (72%) | 0·775 | 19/30 (63%) | 0·296 |
| Neutrophil to lymphocyte ratio | 1 (0–174; 136) | 2·7 (0–44; 4) | 1 (0–9; 5) | 0·0001 | 1·9 (0·1–19; 9) | 0·024 | 1 (0–9; 4) | 0·004 |
| Lactate >4 mmol/L | 255/780 (33%) | 30/35 (86%) | 7/21 (33%) | <0·0001 | 5/21 (24%) | <0·0001 | 14/23 (61%) | <0·0001 |
| Glucose <2·5 mmol/L | 217/780 (28%) | 23/35 (66%) | 5/21 (24%) | 0·005 | 3/21 (15%) | <0·0001 | 7/23 (30%) | 0·015 |
| CSF to blood glucose ratio <0·5 | 380/780 (49%) | 32/35 (91%) | 8/21 (38%) | <0·0001 | 9/21 (43%) | <0·0001 | 8/23 (35%) | <0·0001 |
| Protein >0·4 g/L | 600/947 (63%) | 32/36 (89%) | 10/22 (46%) | 0·001 | 17/22 (77%) | 0·278 | 13/25 (53%) | 0·002 |
Data are median (range; missing) or n/N (%). GCS=Glasgow coma scale. CSF=cerebrospinal fluid. Continuous variables were compared with the Mann-Whitney U test and dichotomous variables with the Fisher's exact test. We included only single infections detected either by culture, molecular diagnostic, or four-fold antibody titre rise between admission and convalescent samples. We calculated p values by comparing patients with Rickettsia typhi or Rickettsia spp, Orientia tsutsugamushi, and Leptospira spp, with patients with conventional bacteria (p<0·05). For the 19 patients PCR positive for R typhi or Rickettsia spp group, 16 had R typhi but because of insufficient template, we were unable to speciate the other three Rickettsia spp.
Not including children <3 years of age because of difficulty of young children reporting these symptoms.
>20 breaths per min for adults (>15 years) and variable for children depending on their age.18
Including patients discharged moribund, extremely likely to have died at home.
The maximum opening pressure that could be measured was 40 cm H2O. Pressures >40 cm H2O were reported as 41 cm H2O.