Diagnosing and Treating Infections: Top Challenge for Neurologists
In what is believed to be the first formal “census” of neurological diseases and their impact, Johns Hopkins researchers have found that brain and nervous system infections are more difficult to diagnose and treat and have a remarkably higher rate of morbidity and mortality compared to other neurological problems.
Researchers have long known that patients with neurological infections, such as encephalitis, meningitis or West Nile disease, represent a significant health care burden because identifying the culprit bacterium, virus or fungus in their blood or tissues is challenging and because treatments often require patients to endure extended and expensive hospitalizations. Patients with probable neurological infections are often subjected to extensive and costly rounds of diagnostic tests, long-term prognosis may be grim, and lengthy rehabilitation or nursing home stays are typical among survivors.
But no formal tally of the extent of the demand and need for care, along with the challenges they pose for a major medical center, had been made, says Avindra Nath, M.D., professor of neurology and director of neuroimmunology and neurological infections at the Johns Hopkins University School of Medicine.
In Nath’s study, publishing in the Oct. 7 Neurology, he and his colleagues report the result of combing through the records of 4,225 patients admitted to either The Johns Hopkins Hospital or Johns Hopkins Bayview Medical Center between October 2004 and December 2005 and seen by a neurologist for any reason.
Among 116 of these patients who were ultimately diagnosed with neurological infections, doctors were able to identify the organisms that caused them in 80, while for 36, the diagnosis and treatment had to depend solely on symptoms when no organism could be found.
Regardless of how they were diagnosed, almost half the patients stayed in the hospital longer than two weeks, and 28 percent required rehabilitation or were debilitated enough to require a long-term care facility, compared to about 19 percent of all patients admitted to Johns Hopkins’ neurology service during the same time period.
About 12 percent of patients with neurological infections died of their illnesses in the hospital, compared to about 3 percent of all Johns Hopkins’ neurology patients.
“We now have numbers to confirm what neurologists have suspected all along,” Nath says. “There is a tremendous morbidity and mortality burden for these patients, and there are serious challenges for hospitals to treat and manage the problems.”
Having the data, Nath says, should help medical specialists set priorities for providing resources and research to enable faster diagnosis and quicker treatments, factors known to improve long-term outcomes. Establishing a tissue bank to store samples from patients who don’t receive a definitive diagnosis may help researchers eventually develop new diagnostic tests, Nath says.
Other researchers who contributed to this study include Kevin Tan, B.M., B.S., M.R.C.P., Subhash Patel, M.B.B.S., Nishiena Gandhi, M.D., M.P.H., Felicia Chow, M.D., and Jeffrey Rumbaugh, M.D., Ph.D.
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