Emerging Infections Network reveals common questions about neuroinfectious diseases
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A 22-year retrospective study of inquires about neuroinfectious diseases in the Emerging Infections Network suggests that neuroinfectious diseases are an “important and challenging component” of infectious disease physicians’ practice.
The study also demonstrates that neurologic complications are especially common in the setting of immunosuppression, according to the results in Open Forum Infectious Diseases.
“Neuroinfectious diseases are challenging to manage for infectious disease specialists and neurologists alike,” Elizabeth Matthews, MD, chief neurology resident at Columbia University Irving Medical Center, told Healio. “We put this study together to understand the challenges faced in the infectious disease community treating the subset of patients with neuroinfectious diseases.”
Matthews and colleagues retrospectively reviewed the Emerging Infections Network (EIN) listserv from February 1997 to December 2019 using search terms related to neurologic diseases. The researchers recorded case summaries, disease type (ie, meningitis), inquiry type (diagnostic approach, result interpretation, management decisions), unique patient populations, exposures, pathogens, ultimate diagnosis and change in clinical care based on responses in order to determine the frequency and characteristics of neuroinfectious disease-related inquiries.
Of 2,348 total inquiries in the EIN, 285 (12.1%) were related to neuroinfectious diseases. According to the study results, the majority of neuroinfectious disease inquiries involved meningitis (34.7%) or encephalitis (19.6%). Other inquires focused on management (40%), diagnostic workup (12%) and result interpretation (8%), and 2.8% specifically involved results of cerebrospinal fluid PCR testing. Nearly a quarter of inquiries (22.1%) involved immunosuppressed patients, 46% of whom were positive for HIV. The pathogens searched for most often were Treponema pallidum (6.7%) and Cryptococcus neoformans (6.3%).
In seventy-four inquiries (25%), patients experienced neurologic symptoms without a clear infection; more than half of these (51.3%) included non-infectious neurologic entities in the differential diagnosis.
A “recurring theme” in regard to the patients with neurologic symptoms but no clearly identified infection focused on “how to approach these patients and what other non-infectious entities should be on the differential diagnosis,” Matthews said. She suggested that the education of both infectious disease specialists and neurologists should include neuroinfectious-specific disease training.
“A focus on meningitis/encephalitis and neuroinfectious diseases in the immunosuppressed population would be beneficial given how commonly these came up,” Matthews said.
The results also highlight the importance of training, she continued.
“Providers should receive training on the interpretation of newer testing modalities, including limitations. The multiplex PCR was the example we identified, but newer technology such as metagenonic sequencing will certainly have limitations of its own that providers should be aware of,” Matthews said. “Infectious disease physicians would likely benefit from training in noninfectious neurologic disorders than can mimic neuroinfectious diseases.”
Finally, she emphasized the importance of fellowships in the training process.
“Neuroinfectious disease fellowships exist, but few people have dedicated neuroinfectious disease training,” Matthews said. “This study further supported the value of this training and the need for more people to complete it.”
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