Acute central nervous system infections in adults--a retrospective cohort study in the NHS North West region
Abstract
BACKGROUND: Over the last 15 years, bacterial meningitis has received considerable attention, including national guidelines, whilst viral central nervous system (CNS) infections have been relatively neglected. A recent pilot study suggested that management of patients with suspected viral encephalitis was often suboptimal. AIM: To examine the relative incidence, clinical features and management of suspected acute CNS infections in adults across the NHS North West Region. DESIGN: A multicentre cross-sectional retrospective cohort study at 10 hospitals across the region over 3 months (from September to December 2007). Following a screen of all patients who had cerebrospinal fluid (CSF) analysis or received intravenous aciclovir and/or third-generation cephalosporin, those with clinical features suspicious of a CNS infection were included. Management was compared with the national meningitis and regional encephalitis guidelines. RESULTS: Three hundred and eighty-five patients were screened; 217 patients had a suspected CNS infection and 44 (20%) had a CNS infection: 18 aseptic meningitis (one herpes simplex virus [HSV]-2), 13 purulent meningitis (four Streptococcus pneumoniae) and 13 encephalitis (three HSV-1). The median (range) time from admission to suspicion of CNS infection and to LP was longer for patients with encephalitis than meningitis [4 (0.3-312) vs. 0.3 (0.1-12) h, P<0.001, and 23 (4-360) vs. 12 (2-48) h, P=0.042, respectively]; and the median time to treatment was longer for aciclovir than cephalosporin [7 (0.5-312) vs. 3 (0.3-312) h, P=0.002]. DISCUSSION: Encephalitis was as common as purulent meningitis, and HSV as common as Streptococcus pneumoniae. However, the management of patients with encephalitis was worse than meningitis. National encephalitis guidelines are needed.
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Brain imaging before lumbar puncture was a potential amendable factor associated with increased time until lumbar puncture in meningitis.
“Consistent with other studies, we found that brain imaging before lumbar puncture was a potential amendable factor associated with increased time until lumbar puncture in meningitis.1,19,20”
From Clinical features and prognostic factors in adults with viral meningitis. (2023) · cites this paper as [19]
The Investigation section reports a significantly longer time to lumbar puncture when neuro-imaging came first (median 18.5 versus 6 hours). It also reports that many patients imaged first had no contraindication to an immediate lumbar puncture, supporting the idea that this was potentially amendable. The timing comparison covers the broader CNS-infection cohort, however, not meningitis patients separately; page numbers are unavailable in our copy. (LLM, conf=0.84)
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A delayed diagnosis in delirium
Michael, B. D., Stoeter, D., & Manji, H. (2016) · doi:10.1093/med/9780199664771.003.0005
Self-citationClinical Management of Viral Encephalitis
Fernández, C., & Solomon, T. (2016) · Springer eBooks · doi:10.1007/978-3-319-33189-8_10
Self-citationInfection or Inflammation and Critical Care Seizures
Schomer, A. C., Ziai, W., Rehman, M., & Nathan, B. R. (2017) · Springer eBooks · doi:10.1007/978-3-319-49557-6_17
The WHO bacterial meningitis guideline and primum non nocere: inaction may also lead to harm
Bodilsen, J., & Nielsen, H. V. (2025) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2025.10.023
Analysis of Cases of Acute Encephalitis Syndrome in a Pediatric Intensive Care Unit
Kumar, S., Kumar, P., Chauhan, S., & Sabharwal, R. (2025) · Journal of Academy of Pediatric Neurology · doi:10.5005/jaopn-11028-0020
A Novel and Sensitive Molecular Method for Nucleic Acid Discovery in CSF Samples
Alshaikh, S. (2011) · Research Explorer (The University of Manchester)
- Authors
- Michael, B. D., Sidhu, M., Stoeter, D., Roberts, M., Beeching, N. J., Bonington, A., Hart, I. J., Kneen, R., Miller, A., Solomon, T., & North West Neurological Infections Network
- Affiliations
- University of Liverpool (GB)
- Venue
- QJM
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-07-24
- Volume
- 103
- Issue
- 10
- Pages
- 749-758
- ISSN
- 0033-5622 (ISSN-L)
- 1460-2725
- 1460-2393
- OpenAlex
- W2105189623
- Semantic Scholar
- ebd59e530c629564cc5378ed2aa85e3c4fd937d0
- Cited by
- 62
- References
- 25
- Citations by year
- 2025: 4 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 4 · 2019: 5 · 2018: 5 · 2017: 5 · 2016: 5 · 2015: 9 · 2014: 2 · 2013: 4 · 2012: 7
- FWCI
- 3.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- QJM (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- LSTM Online Archive (Liverpool School of Tropical Medicine) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research
- Medical Research Council
- Topics
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Keywords
- central nervous system infection, viral encephalitis, bacterial meningitis, aseptic meningitis, herpes simplex virus, Streptococcus pneumoniae, acyclovir, cephalosporins, clinical management, incidence, cerebrospinal fluid analysis, delayed diagnosis, treatment delay
- MeSH terms
- Acute Disease, Adolescent, Adult, Aged, Aged, 80 and over, England, Female, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Central Nervous System Viral Diseases, Central Nervous System Bacterial Infections, Young Adult
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