Comparative analysis of clinical features of central-nervous system infections between two decades / 中华传染病杂志

ABSTRACT

Objective To explore the changes of etiological factors,age of onset,misdiagnosis rates,length of stay and prognosis in central nervous system (CNS) infections between the near 2 decades.Methods A retrospective analysis was conducted between hospitalized patients with CNS infections in affiliated Yijishan Hospital of Wannan Medical College from January 1993 to December 2002 (group A,n =346) and from January 2003 to December 2012 (group B,n =412).The proportions of bacterial infections,Mycobacterium tuberculosis infections,Cryptococcus infections and viral infections between the 2 groups were comparable.Age,gender,underlying diseases and prehospitalization applications of immunosuppressant in two groups were analyzed.The data of prehospitalization misdiagnosis rates,length of stay and prognosis of the two groups were also compared.Measurement data were analyzed by variance analysis or t test,and enumeration data were analyzed by x2 test.Results The proportions of bacterial infections,Mycobacterium tuberculosis infections,Cryptococcus infections and viral infections in two groups were 24.3％ vs 20.1％,29.5 ％ vs 35.7 ％,6.6％ vs 11.4％ and 39.6％ vs 32.8％,respectively (x2 =10.61,P＜0.05).Compared with group A,patients in group B were older [(38.8±8.9) years vs (43.8±11.4) years,t=6.73,P＜0.05],with greater numbers of underlying diseases (1.21 ± 0.34 vs 1.72 ± 0.41,t=18.41,P＜ 0.05) and longer pre-use of immunosuppressants [(7.76 ± 3.58) d vs (12.43 ± 5.96) d,t =12.77,P＜ 0.05].There was no significant difference in sex distributions between the two groups (x2 =0.97,P＞0.05).In group A,the misdiagnosis rates for bacterial infections,Mycobacterium tuberculosis infections,Cryptococcus infections and viral infections were 9.5％,42.2％,69.6％ and 12.4％,respectively; average length of stay was (11.02±5.13) d,(19.18±8.34) d,(21.12±9.26) d and (8.24±3.17) d,respectively; and remission rates were 88.1％,60.8％,34.8％ and 80.3％,respectively.In group B,the misdiagnosis rates for bacterial infections,Mycobacterium tuberculosis infections,Cryptococcus infections and viral infections were 8.4％,29.3％,42.6％ and 11.1％,respectively; average length of staywas (10.13±4.25) d,(17.26±5.82) d,(23.05±7.97) d and (7.05±2.94) d,respectively; and remission rates were 90.4％,72.8％,61.7％ and 84.4％,respectively.The misdiagnosis rates and remission rates of Mycobacterium tuberculosis infections and Cryptococcus infections between group A and group B were of statistical significance (both P ＜ 0.05).Conclusions With the increase of underlying diseases and wide use of immunosuppressants,the causes of CNS infections are changing,among which Mycobacterium tuberculosis infections and Cryptococcus infections are increasing,with a tendency of misdiagnosis and poor prognosis.