Brain Abscess at the University Hospital of the West Indies

Surgical infections of the central nervous system are still attended by high rates of morbidity and mortality, although substantial progress has been made since the advent of computed tomography (CT) scanning technology. In this retrospective review of 25 surgically treated patients with either brain abscess of subdural empyema at the University Hospital of the West Indies, the majority of patients were male and between the ages of 10 and 30 years with a mean age of 16.9 years. Almost half the patients had a hemiparesis on presentation while 60 percent had fever. Subdural empyema was more common than a localised intracerebral abscess which was most frequently located in the frontal lobe. The most common predisposing factors were sinusitis and congenital heart disease. Streptococci spp and Staphylococci spp were the most frequently isolated organisms. All patients underwent CT scanning and surgical intervention. The mortality rate was 20 percent, and 21 percent of the survivors had late seizures. There must be a high index of clinical suspicion and early referral to specialist centres where neuroradiological investigation and prompt neurosurgical intervention can be carried out to minimise morbidity and mortality.(Au)

Investigations of central nervous system viral infection at UHWI, 1998-1999

Preliminary results are presented for viral infections of the CNS at UHWI between July 1998 and June 1999. A total of 168 cases were referred from the following hospitals and distributed as follows: UHWI 119 (70 percent); Bustamante Children's 31 (18 percent); Spanish Town 10 (6 percent); Kingston Public 7 (4 percent); Other 2 (1 percent). Specimens received were acute and convalescent sera, throat swabs, rectal swabs and CSF. Laboratory investigations included viral culture and serology; confirmatory methods included neutralization tests, immunofluorescence (IFA) and polymerase chain reaction (PCR). The clinical diagnoses in the 168 cases included for viral CNS investigations were submitted from only 47/168 (30 percent) of cases. Viral agents were identified in 31/47 (66 percent) of the appropriate specimens received. These viruses included enteroviruses 12/31 (38 percent), human immunodeficiency virus (HIV) 9/31 (29 percent), 3/31 (9 percent) of the HIV positive patients were also positive for toxoplasmosis), dengue 6/31 (19 percent), herpes simplex virus 1/31 (3 percent), rotavirus 1/31 (3 percent), cytomegalovirus 1/31 (3 percent) and influenza 1/31 (3 percent). Enteroviruses, HIV and dengue were the viruses most frequently associated with CNS infections among the 31 cases identified. This however is not a complete representation of CNS associated with viral agents, as appropriate specimens were received from only 30 percent of the cases. This study also demonstrated a definite need for an increased understanding of appropriate specimen collection and submission necessary for the diagnosis of viral CNS infections.(AU)