Presentation, etiology, and outcome of brain infections in an Indonesian hospital: A cohort study

Background

Little detailed knowledge is available regarding the etiology and outcome of CNS infection, particularly in HIV-infected individuals, in low-resource settings.

Methods

From January 2015 to April 2016, we prospectively included all adults with suspected CNS infection in a referral hospital in Jakarta, Indonesia. Systematic screening included HIV testing, CSF examination, and neuroimaging.

Results

A total of 274 patients with suspected CNS infection (median age 26 years) presented after a median of 14 days with headache (77%), fever (78%), seizures (27%), or loss of consciousness (71%). HIV coinfection was common (54%), mostly newly diagnosed (30%) and advanced (median CD4 cell count 30/µL). Diagnosis was established in 167 participants (65%), including definite tuberculous meningitis (TBM) (n = 44), probable TBM (n = 48), cerebral toxoplasmosis (n = 48), cryptococcal meningitis (n = 14), herpes simplex virus/varicella-zoster virus/cytomegalovirus encephalitis (n = 10), cerebral lymphoma (n = 1), neurosyphilis (n = 1), and mucormycosis (n = 1). In-hospital mortality was 32%; 6-month mortality was 57%. The remaining survivors had either moderate or severe disability (36%) according to Glasgow Outcome Scale.

Conclusion

In this setting, patients with CNS infections present late with severe disease and often associated with advanced HIV infection. Tuberculosis, toxoplasmosis, and cryptococcosis are common. High mortality and long-term morbidity underline the need for service improvements and further study.

Latex allergen sensitization due to glove use among hospital staff in Jakarta and related factors

AIM

To know whether latex sensitization risk among nurses is higher than among administration staff and whether latex sensitization risk among operating room nurses is higher than among ward room nurses and also whether there is a correlation between sensitization and sex, age, duration-frequency of exposure, smoking, or atopic status.

METHODS

A cross-sectional study has been conducted in 830 persons from 6 hospitals in Jakarta consisting of 271 operating room nurses, 287 ward room nurses, and 272 administration staff. Subjects completed a guided questionnaire to determine the subject's age, sex, work setting, duration and frequency of exposure or smoking habits and then the subjects underwent an allergy skin prick test with allergens Der p, Der f, Fel d and latex to determine atopic status and latex sensitization.

RESULTS

The proportion of latex sensitization among nurses was 6.1% and among administration staff 1.5%; there was a significant difference (p=0.002). The proportion between operating room nurses was 6.3% and among ward room nurses 5.9%; there was no significant difference (p=0.974). There was a significant correlation between sensitization and mild or severe exposure or atopic status, but no significant correlation between sensitization and sex, age, duration of exposure, or smoking.

CONCLUSION

The risk of latex sensitization among nurses is higher than among administration staff, but the risk among operating room nurses was similar to ward room nurses. Atopic status and frequency of exposure were both associated with latex sensitization.