Clinical course and outcomes in immunocompromised patients with neuroinfections

Abstract

Background: Medical conditions that weaken the immune system facilitate the development of the infections of the nervous system and modify its usual clinical pattern. The aim of our study was to analyze the clinical course and outcomes of immunocompromised patients with neuroinfections. Material and methods: A total number of 201 patients (101 (50%) – immunocompromised) with neuroinfections, collected for 11 years (from 2007 till 2018) in a tertiary neurological center were analyzed. The following conditions were considered to be an immunosuppressed state: age > 65 years, use of immunosuppressive drugs, a history of splenectomy, diabetes mellitus, alcoholism, HIV (human immunodeficiency virus) infected patients, malignancy, pregnancy, autoimmune diseases and systemic vasculitis. The SPSS program was used to perform the descriptive analysis. Results: Immunosuppressed patients were older (49±16.5 vs 39±13.6 years, p=0.000), mostly unemployed (65%, p<0.05), without any significant gender prevalence (men 57%). Encephalitis was the most prevalent syndrome in immunosuppressed (19% vs 6%, p<0.01) and meningitis – in immunocompetent patients (63% vs 49%, p<0.05) and had an abrupt onset in 28% of cases. Patients with immunosuppression had higher level of blood glucose (7.2 vs 5.83 mmol/l, p<0.001) and erythrocyte sedimentation rate (37 vs 27 mm/h, p=0.000). The mortality rate (28% vs 16%, p<0.05) and post-disease disability were noticed more frequently (40% vs 23%, p<0.01) in immunocompromised patients. Conclusions: Immunosuppression is frequent in patients with neuroinfections, delays diagnosis and leads to a high level of mortality and disability.