Epidemiology, Outcomes and Prognosis of Central Nervous System Infections in Singapore - preliminary results from the Singapore Neurologic Infections Programme (SNIP) (P5.098)

Objective: To describe the epidemiology, outcomes and prognosis of Central Nervous System (CNS) infections in Singapore. Background: CNS infections often have devastating consequences, but the etiology is rarely identified with certainty. To address this knowledge gap, we conducted a prospective study of CNS infections in Singapore. Design/Methods: Patients aged ≥16 years who met the inclusion criteria were enrolled in 5 adult tertiary hospitals in Singapore, between August 2013 and December 2016. Demographics, neuroimaging, neurophysiology and biochemical results were collected. Cases were classified as “Confirmed” if the etiological agent was detected by culture in the CSF or “Probable” if it was detected by molecular methods. The modified Rankin Scale (mRS) was recorded at enrollment, 2 weeks and 6 months, with scores of 0–2 classified as good and 3–6 as poor outcome. Results: Out of 2061 patients screened, 199 met the inclusion criteria. A total of 106 (53.2%) cases of meningitis, 65 (32.7%) cases of meningoencephalitis and 28 (14%) cases of encephalitis were diagnosed. An etiologic agent was identified in 119 (60%) of cases. Mycobacterium tuberculosis (MTb) was the most common cause of meningitis and meningoencephalitis with 23 (13.5%) cases. Herpes simplex virus was the most common etiology for encephalitis with 3 (10.7%) cases. Immune-mediated etiologies accounted for 8 (4%) of the total cases. Fatal outcomes were observed in 7 (3.5%) patients. Absence of focal weakness (aOR 0.024 95% CI 0.001–0.535 p=0.018) and absence of altered mental status (aOR 0.03 95%CI 0.002–0.43 p=0.009) at admission were associated with good outcomes at 6 months. Vomiting was associated with poor prognosis (aOR 17.91 95% CI 1.12–286.04 p=0.041). Conclusions: MTb was the most common etiologic agent of meningitis and meningoencephalitis. Our study identified etiologic diagnoses, clinical and biochemical results that correlated with outcome of CNS infections. It also underscores the need for better diagnostic tools for etiologic confirmation. Study Supported by: Singapore Infectious Disease Initiative (SIDI) Cross Institutional Research Grant (SIDI/2013/003) Disclosure: Dr. Tan has nothing to disclose. Dr. Chan has nothing to disclose. Dr. Soon has nothing to disclose. Dr. Shafi has nothing to disclose. Dr. Chan has nothing to disclose. Dr. Ooi has nothing to disclose. Dr. Low has nothing to disclose. Dr. Sessions has nothing to disclose. Dr. Ooi has nothing to disclose. Dr. Wang has nothing to disclose. Dr. Vincent has nothing to disclose. Dr. Wijaya has nothing to disclose.