The ‘Not So Common’ Causes of Central Nervous System Infection in Hong Kong: Diagnoses You Cannot Afford to Miss

Abstract

Infection of the central nervous system is an infectious disease emergency frequently encountered by the neurologist in clinical practice. Early diagnosis and treatment is essential in reducing the significant morbidity and mortality associated with these infections. Unfortunately, up to two-thirds of encephalitis cases and a large number of chronic or partially treated acute meningitis cases remain of unknown etiology despite an extensive diagnostic workup. In a metropolitan city with a high standard of healthcare like Hong Kong, most physicians are competent in managing patients with central nervous system infections caused by common pathogens with established diagnostic algorithms and treatment strategies. However, cases caused by unusual pathogens or those with atypical manifestations often cause diagnostic dilemmas, and hence, delay in treatment. An individualized clinical management approach with a specific focus on epidemiological risk assessment and close liaison with the clinical microbiology laboratory for state-of-the-art diagnostic tests are essential in deciphering the secrets of infections caused by these “not so common” bugs.