The Global Burden, Challenges In Diagnosis, Treatment and Rehabilitation of Children Presenting With Central Nervous System Infections In Resource Limited Settings

The global burden of CNS infections in Low & Low Middle Income countries
Shaheen Akhter

Central nervous system (CNS) infections are a major worldwide health concern that impact millions of children annually. Children's CNS infections have an influence not just on the individual but also on families, communities, and global healthcare systems. Gaining an understanding of the aetiology, clinical symptoms, risk factors, epidemiology, and management of CNS infections in children is essential to enhancing treatment outcomes and mitigating the devastating effects of these illnesses.

Moreover, survivors may face a substantial burden of disability and a high mortality rate. The overall incidence of CNS infections among children in developing countries are 726 cases per 100,000, compared to 11 cases per 100,0002 in developed countries. This reflects poor sanitation, limited access to healthcare, and challenges in putting preventive measures in place.

Diagnoses, the prevention of antibiotic resistance, and the burden of chronic, serious diseases like CNS tuberculosis and emerging diseases like COVID-19 and dengue with central nervous system presentations are all problematic in low-resource settings.

In this context, exploring the global burden of CNS infections in children becomes essential for guiding public health interventions like vaccination & hygiene, promoting research collaboration between institutions of high and low resource setting countries to better understand the epidemiology, pathogenesis and treatment of CNS infection, sharing resources such as diagnostic tests and building capacities to implement standardized treatment protocols for an ultimate quality care to ensure the well-being of paediatric populations in low resource settings.

Clinical, phenomenology, and recent advances in diagnosis and treatment of acute CNS infections
Pratibha Singhi

CNS infections can be diffuse or focal and can have acute subacute or chronic presentations. Most acute CNS infections have a common presentation with fever seizures and altered sensorium. It is important to look for clues in the history and in the examination to be able to have a clinical phenotype related to certain etiologies. It is a very important to know the prevalent CNS infections in the particular geographic region. Certain clues such as typical rashes and skin lesions such as eschars and other systemic involvement help. The definitive etiological diagnosis of CNS infections usually rests on CSF examination. The usual bacterial cultures have been replaced by nucleic acid amplification tests and now the multiplex PCR test can detect a large number of etiological organisms simultaneously. Advances in MR imaging with faster and newer sequences have made a paradigm shift in the diagnosis of CNS infections based on typical patterns. Despite newer antibiotics, the prognosis of CNS infections has not improved significantly. However, changes in supportive management, including the use of liberal fluids and measurement of raised intracranial pressure to maintain an optimal, cerebral perfusion pressure have become important goals and have contributed to improved outcomes. In this talk, the various diagnostic tests, including the use of neuroimaging, and the strides made in the supportive therapy and cares of children with acute CNS infections will be covered

Phenotypical and radiological clue for diagnosis of CNS tuberculosis

According to World Health Organization (WHO) Global TB Report 2018, there were an estimated 10 million new cases and 1.6 million deaths due to TB. Even though CNS-TB accounts for only 1–10% of all TB cases, it has the highest mortality and morbidity among all TB infections. Children are vulnerable to CNS tuberculosis due to their low immunity. Early diagnosis and management of the disease, though difficult, is essential to avoid death or neurologic disability. Hence, a high degree of suspicion and a combined battery of tests including clinical, bacteriological and neuroimaging help in the diagnosis of CNS TB. In this talk, we will discuss the changing treatment landscape for drug-susceptible and drug-resistant paediatric CNS tuberculosis and address the current knowledge gaps for
improving patient outcomes. CNS-TB can have protean presentations. It includes TBM, tuberculoma, tubercular abscess, tuberculous encephalopathy, and hypertrophic pachymeningitis. In the spinal cord, it can cause spinal tuberculoma, tuberculous myelitis, Pott's spine with epidural abscess and spinal
arachnoiditis. The neuroimaging often mimics other infectious and noninfectious neurological conditions. The management of CNS TB is often difficult due to multiple complications and resistance to drugs. The symposium will further aim to highlight the management of CNS TB based upon the clinical phenotypes, neuroimaging and discuss complications and guidelines.

A new paradigm in CNS infection: COVID 19 in pediatric population
Nazmul Hoque

The emergence of COVID-19 has brought a new paradigm in CNS infections, including in the pediatric population in Bangladesh a low income health care setting. Although the incidence of severe neurological complications of COVID-19 in children is relatively low, cases of encephalitis, acute disseminated encephalomyelitis, and Guillain-Barré syndrome have been reported. Additionally, the pandemic has disrupted routine healthcare services, leading to delays in the diagnosis and treatment of CNS infections. The situation is particularly challenging in resource-limited settings such as Bangladesh, where the burden of CNS infections is already high. Thus, there is a need for increased awareness, surveillance, and preparedness for the neurological complications of COVID-19 in children in Bangladesh, as well as for measures to mitigate the impact of the pandemic on routine healthcare services for CNS infections. The symposium will focus on strategies for early recognition, appropriate management, and rehabilitation of neurological complications of COVID-19 in resource-poor settings. The proposed talk will discuss (1) the prevalence and spectrum of neurological complications of COVID-19 (2) the challenges of diagnosing and treating neurological complications (3) management of severe neurological complications of COVID-19 & (4) rehabilitation and long-term follow-up for patients who have recovered from neurological complications of COVID-19 in resource-poor settings.