Non Traumatic Intracranial Infections at the University Teaching Hospital Lusaka, Zambia

Abstract

Background: Non traumatic intracranial infections are a well recognized disease process encountered in neurosurgery and otolaryngology practices. In this case series study, we analyze the patients that presented with this condition to the neurosurgical unit of the University Teaching Hospital in Lusaka, Zambia.
Methods: This is a prospective analysis of a case series of patients that were treated for non traumatic intracranial infections. The analysis involved the following parameters: age, sex, clinical presentation, HIV serostatus, CT/neurosurgical findings, microbiology, and treatment outcome. This was done over a 3-year period.
Results: Eighteen patients were treated for non traumatic intracranial infections, of which 12 were male and 6 were female. The youngest patient was 9 and the oldest was 70, with a mean age of 25.33 years. Headache and fever were the most common clinical presentation, followed by sinusitis. Six patients were HIV-positive and 5 were already on HAART prior to presentation. Intracerebral abscesses, both solitary and multiple, were seen in 10 patients, while epidural and subdural empyema were present in 2 patients each. In one patient, localized encephalitis was seen, and the other 3 patients had a mixture of intracerebral abscess and subdural empyema. Gram-positive cocci comprising streptococci and staphylococci were isolated in 10 cases, while negative cultures were seen in 4 and actinomycete was seen in 1 patient. Fourteen patients had a good outcome, while 4 patients died, including 3 with a positive HIV serostatus. Two of these HIV-positive patients had very low CD4 counts. 
Conclusion: The pattern for non traumatic intracranial infections seen at the University Teaching Hospital in Lusaka is not different from other published series. However, the role of HIV in the treatment outcome needs further study.

Keywords: Intracranial, abscess, HIV, Zambia