Table 2.
Clinical characteristics and laboratory investigations of CNS infection patients
| Parameter | Case 1 43 y.o./M* | Case 2 19 y.o./F† | Case 3 32 y.o./F† | Case 4 21 y.o./M* |
|---|---|---|---|---|
| Clinical characteristics | ||||
| Onset of fever (day) | 3 | 2 | 7 | 1 |
| Fever | + | + | + | + |
| Headache | + | + | − | − |
| Altered consciousness | + | + | + | + |
| Seizures | − | + | + | − |
| Nuchal rigidity | − | + | − | − |
| Joint pain | − | + | − | − |
| Skin rash | − | − | − | − |
| Diarrhea | − | − | + | + |
| Abdominal pain | − | − | − | + |
| Motor dysfunction | Facial nerve palsy, left hemiparesis | − | − | − |
| Glasgow Coma Scale | 13 | 12 | 13 | 15 |
| Blood pressure (mm/Hg) | 120/80 | 110/70 | 140/90 | 100/62 |
| Heart rate (beats/min) | 80 | 107 | 102 | 125 |
| Laboratory investigation | ||||
| Blood test | ||||
| Hemoglobin (mmoL/L) | 6.21 | 6.27 | 6.7 | 11.8 |
| Platelets(counts/μL) | 181,000 | 310,000 | 516,000 | 46,000 |
| White blood cells (cells/μL) | 5,000 | 11,800 | 12,280 | 11,680 |
| C-reactive protein (mg/L) | ND | ND | ND | 35.4 |
| Culture | ND | Negative | ND | ND |
| HIV test | Positive | Negative | Negative | Negative |
| CSF findings | ||||
| White blood cells (cells/μL) | ND | 100 (mononuclear cell) | 61 (mononuclear cell) | 11 (mononuclear cell) |
| Protein (mg/dL) | ND | 30 | 120 | ND |
| Glucose (mg/dL) | ND | 100 | 24 | 44 |
| CSF/blood glucose ratio | ND | 0.82 | 0.22 | 0.55 |
| Acid-fast bacilli stain | ND | Negative | ND | Negative |
| Gram stain | ND | Negative | ND | Negative |
| Real-time PCR (GeneXpert) | ND | ND | Negative | Negative |
| M. tuberculosis Culture | ND | ND | Positive | Negative |
| Chest X-ray | Normal | Normal | Pleural effusion | Normal |
| Brain CT scan | ND | Subdural hyperdensity in left frontotemporal lobe and mild diffuse cerebral edema | Multiple lacunar infarct | Normal |
| Comorbidities | HIV | Epilepsy | None | None |
| Presumptive clinical diagnosis | Toxoplasma encephalitis | TB meningitis | TB meningitis | Viral encephalitis |
| Treatment | Anti-toxoplasma and antiretroviral drugs | Anti-epilepsy, antibiotics, and anti-TB drugs | Anti-TB drugs | Acyclovir |
| Outcome at discharge | Residual hemiparesis | No neurological sequelae | Moderate neurological sequelae | No neurological sequelae |
CNS = central nervous system; CSF = cerebrospinal fluid; CT = computed tomography; ND = not done; y.o. = year old.
*
M = Male.
†
F = Female.