Author(s): Aifa B.L.; Flatley J.; Prince T.; Solomon T.; Griffiths M.J.; Herini E.S.; Wibawa T.
Source: Developmental Medicine and Child Neurology; Jan 2019; vol. 61 ; p. 74-75
Publication Date: Jan 2019
Publication Type(s): Conference Abstract
Available at Developmental Medicine and Child Neurology – from Wiley Online Library Full Collection
Abstract:Background: Central nervous system (CNS) infections, such as meningitis and encephalitis, remain life-threatening, especially in developing countries. Knowledge of the specific pathogen causing the disease is essential to guide appropriate hospital treatment and inform future vaccine strategy. However, the aetiology of CNS infections, in much of Indonesia, including Yogyakarta, is frequently unknown. Method(s): A prospective hospital-based study was conducted in children aged 1 month-18 years at Dr Sardjito Hospital, a large tertiary referral hospital in Yogyakarta, from February 2015-2018. We introduced systematic testing of cerebrospinal fluid (CSF), including pathogen-specific PCR and antibody tests to identify causative pathogens into the local laboratory (to supplement routine microbiology culture). Result(s): We recruited 355 children with clinically suspected CNS infections. CSF specimens were obtained from 242 children, 121 had CSF pleocytosis (leucocyte count of >4 cells/mm3). Fifty-one children (51/121 [42%]) died in hospital. Pathogens were detected in 51 cases; 13 by routine culture, 26 by pathogen specific PCR and 12 by antibody testing. We have identified new cases of Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Mycobacterium tuberculosis (Mtb), Escherichia coli (E. coli) and Streptococcus agalactiae. Dengue, Mtb and E. coli were the most commonly identified pathogens in these children. Introduction of systematic testing at the local laboratory increased pathogen detection by 30% (from 11% to 42%). Conclusion(s): Use of systematic pathogen-specific PCR and antibody testing of CSF has dramatically improved knowledge on the aetiology of CNS infections in children in a large regional hospital in Indonesia. This knowledge offers to inform clinical management of CNS infections. For example, through dissemination of results, local clinicians will have a higher index of suspicion for treating mycobacteria among children with suspected CNS infection. Longer-term, uptake of molecular diagnostics will facilitate more targeted patient treatment, reduce antibiotics use and improve patient care.