Challenges in diagnosis of central nervous system infections using conventional method: Need for better approach in Rwanda

Central nervous system (CNS) infection is a common and serious disease that needs rapid and appropriate diagnosis for an appropriate treatment. However, in most recourse limited setting including Rwanda, conventional microbiological method is the only way to establish a confirmed infectious etiology. This was a 4 years retrospective review of registers and electronic laboratory records aimed to determine the causative agents in hospitalized patient’s suspected to be suffering from CNS infection at four referral hospitals in Rwanda. In this review, the majority of participants (48%) were in the age group between 25 and 44 years (median = 34), with 53 and 47% being males and female, respectively. Cerebrospinal fluid (CSF) was clear in 67% (112/168), turbid in 30% (50/168) and bloody in 3% (6/168) patients. Only 1% (2/168) of the samples had WBC count >1,000 cells/mm3 and 13% (21/168) had WBC count between 101 and 1,000 cells/mm3, WBC count between 10 and 100 cells/mm3 was present in 10% (17/168) whereas <10 cells/mm3 was present in 76% of the samples. The present data above was from one selected referral hospital out of four sites used in this study, whereby all required data were funded during data collection. Out of 208, positive CSF was identified from four sites; C. neoformans was the most frequent pathogen isolated, followed by Streptococcus pneumoniae representing 71.6 and 9.6%, respectively. Other pathogens identified included Acinetobacter spp. which represented 4.3%, S. aureus 3.8%, E. coli 2.8% and K. pneumonia 1.9%. Both N. meningitides and H. influenzae type B were isolated in only 0.48% for each. The present study reveals that the diagnostic of CSF infection using conventional method is alarmingly low across all tertiary hospitals, suggesting further studies using molecular methods to shed light on the etiological agent of CNS infections in Rwanda.