# Clinical Profiles and Outcomes of Adult Patients With Central Nervous System Infections: A Descriptive Cross-Sectional Study at a Single Private Tertiary Hospital in Quezon City, Philippines

## TL;DR

This study examines the clinical features and outcomes of central nervous system infections in adults at a Philippine hospital, highlighting common symptoms and diagnostic challenges.

## Contribution

The study provides local epidemiological data on CNS infections in a single private tertiary hospital in the Philippines.

## Key findings

- Fever, headache, and neurologic deficits were the most common clinical manifestations.
- Tuberculous meningitis was the most frequently observed CNS infection.
- Low CSF culture positivity rates were attributed to early antibiotic use and fastidious organisms.

## Abstract

Central nervous system infections (CNSI) remain a significant cause of morbidity and mortality worldwide, yet data on local epidemiology, causative agents, and antimicrobial susceptibility patterns are limited. This paper presents a census of observed CNSI cases at a single institution to inform future studies.

To address these objectives, we conducted a retrospective cross-sectional study of adult patients with CNSI admitted from January 2017 to December 2024. We included all spectrums of CNSIs. We accessed patient charts using the hospital's electronic databases. We gathered data on demographics, clinical manifestations, risk factors, diagnostic methods, type and likelihood of CNSI, cerebrospinal fluid (CSF) analysis and measurements, etiologic agent, antimicrobial susceptibilities, treatment given, and outcomes.

Out of 357 charts reviewed, 184 met the inclusion criteria, with fever (64.7%), headache (43.5%), and neurologic deficits (36.4%) as the most common manifestations. The majority had elevated opening pressures (≥20 cm H₂O), CSF lymphocytic pleocytosis, elevated protein (≥50 mg/dL), and hypoglycorrhachia (CSF/serum glucose ratio ≤0.5). Microbiologic CSF analysis had a low positivity rate of 25%. A mixture of bacterial, fungal, viral, and parasitic agents was identified.

Tuberculous (TB) meningitis remains the most common CNSI observed. Not all patients displayed CSF pleocytosis or hypoglycorrhachia, and possible explanations include an ineffective mounting of a proper immune response in the immunocompromised or early CSF collection before an inflammatory response has occurred. Factors identified as leading to a low CSF culture positivity rate include early antibiotic initiation and fastidious organisms as causative agents. Delayed lumbar puncture or drainage is inevitable in some cases; hence, prompt antibiotic therapy is important to reduce morbidity and mortality.