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. 2025 Oct:159:108002.
doi: 10.1016/j.ijid.2025.108002. Epub 2025 Aug 5.

Causative pathogens and predictors of unfavourable outcomes in central nervous system infections in resource-limited settings

Do Van Dong  1 , Vu Viet Sang  2 , Nghiem Xuan Hoan  2 , Nguyen Viet Ha  2 , Nguyen Thi Khanh Linh  2 , Bui Tien Sy  2 , Nguyen Trong The  2 , Hoang Xuan Quang  3 , Tran Thi Lien  4 , Van Dinh Trang  5 , Peter G Kremsner  6 , Le Huu Song  1 , Silke Peter  7 , Dennis Nurjadi  8 , Thirumalaisamy P Velavan  9
Affiliations
Free article

Causative pathogens and predictors of unfavourable outcomes in central nervous system infections in resource-limited settings

Do Van Dong et al. Int J Infect Dis. 2025 Oct.
Free article

Abstract

Objectives: This study investigated the impact of causative pathogens on the outcomes of central nervous system (CNS) infections and assessed clinical parameters to identify patients at risk for unfavourable outcomes.

Methods: Patients with suspected CNS infections underwent blood and cerebrospinal fluid (CSF) culture and advanced molecular testing, including real-time PCR assays for bacterial and viral pathogens. Patients were classified into clinical categories and their outcomes assessed using the Glasgow Outcome Scale.

Results: Pathogens were identified in 24% (80/330) of patients, with Mycobacterium tuberculosis, Klebsiella pneumoniae, and Acinetobacter baumannii being the most common. Mortality was 10%, with fungal meningitis and dual infections having the highest rates. Unfavourable outcomes were observed in 57% of patients. The most common pathogens associated with unfavourable outcomes were M. tuberculosis followed by K. pneumoniae, A. baumannii, and HSV-1. Multivariate analysis identified community-onset infection as a protective factor, while a longer duration of illness before admission (≥5 days) and altered mental status on admission were significant predictors for unfavourable outcomes. Furthermore, the timely administration of appropriate empirical therapy was significantly associated with a reduced risk of mortality.

Conclusions: CNS infections in northern Vietnam have diverse causes and overlapping clinical features, complicating diagnosis and management.

Keywords: Bacterial meningitis; Central nervous system infections; Fungal meningitis; Tuberculous meningitis; Vietnam; Viral encephalitis/meningitis.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Thirumalaisamy P Velavan reports article publishing charges was provided by German Academic Exchange Service. Dennis Nurjadi reports financial support was provided by Shionogi and Co Ltd. Dennis Nurjadi reports financial support was provided by Cephied. The co-author Dennis Nurjadi declares that he received speakers honoraria from Shionogi and Cepheid, which outside the scope of this article. All other authors reported no conflict of interest. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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