Patterns of central nervous system infections in Pakistan: a cross-sectional multicenter study

Zainab Memon; Safia  Awan; Ibrar Rafiq; Shafaq  Saleem; Saleem  Barech; Muhammad Arif  Nadeem Saqib; Syed Ahmed Asif; Haris Majid  Rajput

doi:10.56310/pjns.v21i01.389

Zainab Memon Aga Khan University Hospital, Karachi
Safia Awan Aga Khan University Hospital, Karachi
Ibrar Rafiq Health Research Institute, NIH/Allied Health Professionals Council, Islamabad
Shafaq Saleem Aga Khan University Hospital, Karachi
Saleem Barech Bolan University of Medical and Health Sciences, Quetta
Muhammad Arif Nadeem Saqib National Skills University, Islamabad/Pakistan Health and Research Council, Islamabad
Syed Ahmed Asif Liaquat National Hospital, Karachi
Haris Majid Rajput Pakistan Institute of Medical Sciences, Islamabad

DOI: https://doi.org/10.56310/pjns.v21i01.389

Keywords: CNS infection, Tuberculous meningitis, Bacterial meningitis, Vaccination

Abstract

Background and Objective:

In low- and middle-income countries, central nervous system infections are amongst the neurological entities associated with significant disability. Despite the availability of both preventative and antimicrobial treatment, management of CNS infections continues to be a great challenge. The objective of this study was to assess the pattern of CNS infections across multiple urban and rural centers in Pakistan.

Methods:

A cross-sectional observational study was conducted across 39 outpatient neurology centers in Pakistan, including both public and private setups from August 2017 to December 2019. Data on demographics, comorbidities, and categorization of CNS infections were obtained from the hospital records. Disability as a measure of outcome was classified using the Modified Rankin Scale (mRS). SPSS 25.0 was used for statistical analysis of the data.

Results:

A total of 455 patients with CNS infections were analyzed. Tuberculous meningitis (38%) was the most prevalent, followed by bacterial meningitis (27.9%) and viral meningitis (22.9%). Fungal infections (2.9%), brain abscesses (2.4%), and rare cases of amoebic encephalomyelitis (0.4%) were also observed. The mean age was 38.8 years, with 40.2% of cases occurring in young adults (18–30 years). Males (53.4%) were slightly more affected than females. Hypertension (16.3%) and diabetes (10.1%) were the most common comorbidities. Post-infection disability was seen in 15.7% of cases, with 4.6% being bedridden.

Conclusion:

The findings indicate that tuberculosis meningitis and bacterial meningitis constitute the majority of CNS infections. Early diagnosis, improved vaccination coverage, and better antimicrobial stewardship play a key role in long-term outcomes