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Burden of neuroinfectious diseases on the neurology service in a tertiary care center

From the Department of Neurology, Johns Hopkins University, Baltimore, MD.

Address correspondence and reprint requests to Dr. Avindra Nath, Department of Neurology, 509 Pathology, 600 N. Wolfe St., Baltimore, MD anath1{at}jhmi.edu

Background: Neurologic infections have the potential to cause death and suffering. These disorders often go unrecognized or are misdiagnosed. There has yet not been a census of neurologic infections conducted in a hospital setting. We aimed to determine the burden of neurologic infections on the neurology service in a tertiary care center and identify challenges in the diagnosis and treatment of these infections.

Methods: We reviewed retrospectively all inpatients diagnosed with any neuroinfectious disease evaluated at Johns Hopkins Medical Institutions between October 2004 and December 2005. We recorded information on hospital admission, clinical features, microbiologic analysis, neuroimaging, EEG, pathology, treatment, and outcome.

Results: A total of 116 of 4,225 patients admitted to or consulted on by the neurology service were identified. Eighty percent of patients were aged between 18 and 65 years. Fifty-two patients were immunocompromised, of which 28 patients had HIV infection. Overall, 86 microbiologic agents were identified in 80 patients. The commonest causes were viral, followed by bacterial and fungal infections. However, 31% of patients remained without an identifiable microbiologic etiology. Hospitalization periods were long, with 43% of patients staying beyond 2 weeks. There was significant morbidity: 28% of patients required rehabilitation or long-term care, and 12% died.

Conclusions: Neurologic infections have a major socioeconomic impact because they result in prolonged hospitalizations, expensive diagnostic tests and treatments, and long-term debilitation or death in young patients. Though potentially curable conditions, the burden of undiagnosed infections remains high.

Abbreviations: CMV = cytomegalovirus; Crypto = Cryptococcus neoformans; EBV = Epstein–Barr virus; HSV = herpes simplex virus; JCV = JC virus; JHMI = Johns Hopkins Medical Institutions; NA = not applicable; neuro-ID = neuroinfectious disease; RPR = rapid plasma reagin; Toxo = Toxoplasma gondii; VZV = varicella-zoster virus.

Disclosure: The authors report no disclosures.

Received February 20, 2008. Accepted in final form July 3, 2008.