*Co esponding au ho : Mohammad Emam Mohammad
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
Epidemiology, clinical cha ac e is ics, and ou comes o pa ien s ha ing cen al
ne ous sys em in ec ions in Almaza e e mili a y hospi al: A e ospec i e s udy
Mohammad Emam Mohammad 1, *, Abou Bak Fa ag 2, Aisha Abo EL Fo oh 3 and Mohamed Abdel Salam
Elgoha y 1
1 Depa men o opical medicine and in ec ious disease, Mili a y Medical Academy, Cai o, Egyp .
2 Depa men o p e en i e, social and occupa ional medicine, Mili a y Medical Academy, Cai o, Egyp .
3 Depa men o public heal h, communi y medicine, en i onmen al and occupa ional Medicine, Facul y o medicine, Ain
Shams Uni e si y, Cai o, Egyp .
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 098-115
Publica ion his o y: Recei ed on 31 Augus 2025; e ised on 07 Oc obe 2025; accep ed on 10 Oc obe 2025
A icle DOI: h ps://doi.o g/10.30574/gscbps.2025.33.1.0385
Abs ac
Objec i e: This s udy aimed o desc ibe he epidemiology, clinical cha ac e is ics, managemen , and ea men
ou comes o pa ien s diagnosed wi h cen al ne ous sys em (CNS) in ec ions a a e ia y ca e hospi al in Egyp .
Me hods: A e ospec i e analysis was conduc ed on 104 pa ien s admi ed wi h suspec ed CNS in ec ions be ween July
2021 and Oc obe 2023. Da a ex ac ed om hospi al eco ds included pa ien demog aphics, clinical ea u es,
labo a o y and neu oimaging esul s, ea men egimens, and inal ou comes.
Resul s: The median pa ien age was 50 yea s, wi h a male p edominance (71.2%). The mos common diagnoses we e
encephali is (45.2%) and meningi is (41.3%). A causa i e pa hogen was iden i ied in only 42.3% o cases,
wi h S ep ococcus pneumoniae being he mos equen (13.5%). No e iology was ound in 57.7% o cases. Diabe es
was he mos equen como bidi y (27.9%). The uni e sal clinical ea u e was dis u bed consciousness, ollowed by
e e and headache. The mos used empi ical ea men was a combina ion o ce iaxone, ancomycin, and acyclo i
(57.6%). The o e all cu e a e was 80.7%, and he mo ali y a e was 5.7%. All cases o c yp ococcal meningi is and
10% o ce eb al mala ia cases we e a al.
Conclusion: In his coho , CNS in ec ions p ima ily a ec ed olde adul s, wi h a high a e o unknown e iology. The use
o empi ical b oad-spec um he apy was associa ed wi h a a o able o e all ou come. Howe e , he indings highligh
an u gen need o enhanced diagnos ic me hods o iden i y pa hogens, especially in a al ungal and pa asi ic in ec ions,
o guide a ge ed ea men and po en ially imp o e su i al.
Keywo ds: Cen al ne ous sys em in ec ions; Meningi is; Encephali is; Epidemiology; T ea men ou comes; Egyp
1. In oduc ion
Cen al ne ous sys em (CNS) in ec ions ep esen a c i ical challenge in medicine due o hei se e e consequences
and he impe a i e o p omp ecogni ion, diagnosis, and ea men o sa e li es. These in ec ions encompass dis inc
clinical synd omes like acu e bac e ial meningi is, i al meningi is, and encephali is, alongside ocal in ec ions such as
b ain abscesses, subdu al empyema, and in ec ious h ombophlebi is. O en, hese condi ions ini ially p esen wi h non-
speci ic p od omal symp oms like e e and headache. C ucial o ea ly managemen is he u gen di e en ia ion
be ween hese condi ions, iden i ica ion o he causa i e pa hogen, and ini ia ion o app op ia e an imic obial he apy.
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 098-115
99
Global and Regional Bu den o CNS In ec ions Globally, meningi is emains a o midable disease, causing an
es ima ed 250,000 dea hs in 2019 and lea ing one in i e a ec ed indi iduals wi h se e e long- e m sequelae.
Vaccina ion p og ams, such as Egyp 's expanded na ional accina ion p og am agains Neisse ia meningi idis and he
in oduc ion o in luenza, measles, mumps, and ubella accines, a e expec ed o signi ican ly educe local incidence
a es o hese in ec ions. Vi al meningi is is mo e p e alen han bac e ial meningi is, hough ypically less se e e. A
signi ican p opo ion (up o 70%) o encephali is cases ha e unknown e iologies, and non-in ec ious p ocesses can also
cause he condi ion. CNS in ec ions a e clinically cha ac e ized by symp oms such as e e , headache, omi ing, seizu es,
loss o consciousness, al e ed senso ium, ocal neu ological de ici s, and blu ed ision, wi h a ia ions depending on
he e iology and b ain in ol emen [1].
Low- and middle-income coun ies (LMICs) disp opo iona ely bea he bu den o CNS in ec ions. These in ec ions can
esul om a wide ange o i uses, leading o a ied neu ological mani es a ions. Common i al e iologies include
en e o i uses, he pes simplex i us (HSV), a icella-zos e i us (VZV), cy omegalo i us (CMV), Eps ein–Ba i us
(EBV), and human immunode iciency i us (HIV). C yp ococcus is he mos common cause o ungal CNS in ec ions,
pa icula ly in sub-Saha an A ica, whe e i is a leading cause o meningi is [1].
The global bu den o disease epo ed a 21% educ ion in dea hs om CNS in ec ions be ween 1990 and 2016, bu an
inc ease in incidence om 2.50 o 2.82 million cases du ing he same pe iod. While i al meningi is is mo e common,
bac e ial meningi is is mo e se ious i le un ea ed. Vi al CNS in ec ions ange om 0.26 o 17 cases pe 100,000
people, wi h incidence a ying by age and o he ac o s. In he U.S., i al meningi is incidence is app oxima ely 0.7 cases
pe 100,000 people pe yea , and i al encephali is is 1.7 cases pe 100,000 people pe yea . Resou ce-limi ed se ings
ace a pa icula ly high bu den o i al CNS in ec ions, associa ed wi h high mo bidi y and mo ali y a es. Fo ins ance,
acu e encephali is synd ome in sub-Saha an A ica has an es ima ed annual incidence o 4.3 cases pe 100,000 people
and a case- a ali y a e o up o 45% in some egions [1].
Fungal CNS in ec ions con ibu e signi ican ly o mo bidi y and mo ali y globally, especially in immunocomp omised
indi iduals. C yp ococcosis, he mos common ungal in ec ion a ec ing he CNS, accoun s o an es ima ed 223,100
cases and 181,100 dea hs annually wo ldwide. Among people li ing wi h HIV, app oxima ely 152,000 cases o
c yp ococcal meningi is occu each yea , wi h 112,000 dea hs, p edominan ly in sub-Saha an A ica. O he ungal
pa hogens like Aspe gillus and Candida species also cause signi ican mo bidi y and mo ali y, pa icula ly in
immunocomp omised pa ien s. Mycobac e ial in ec ions, especially CNS ube culosis, a e common in Sou heas Asia,
accoun ing o 1% o all TB cases and being he mos equen o m o CNS TB [1].
Immune Responses in CNS In ec ion: The CNS has an "immune p i ilege" s a us due o local issue ba ie s and
immunosupp essi e mic oen i onmen s, es ic ing he low o cells, in ec ions, o mac omolecules. Key physical
ba ie s include he blood-b ain ba ie (BBB), blood-ce eb ospinal luid (CSF) ba ie , and a achnoid ba ie . Unde
pa hological condi ions, pe iphe al immune cells can c oss he BBB. CSF anspo h ough skull channels and in o
ma ow ca i ies sugges s a mechanism o pa hogens o induce immune cell elease in esponse o in lamma ion [2].
T-cell-media ed immune egula ion in ol es esiden mic oglia and pe i ascula mac ophages inhibi ing o eign
bodies. T cells a e c ucial o e adica ing i al and in acellula bac e ial in ec ions, o en clea ing i al in ec ions non-
cy oly ically. Ac i a ed T cells can mo e om blood essels o he suba achnoid space ia he cho oid plexus s oma.
Bo h CD4+ and CD8+ T lymphocy es a e ound in meninges, cho oid plexus, pa enchyma, and naï e b ain. Myeloid cells
as an igen-p esen ing cells (APCs) ac i a e and ec ui an i i al T cells [2].
Immune esponses in he CNS a e di ided in o inna e and adap i e. The ini ial s ong inna e esponse h oughou he
CNS p o ides an imic obial de ense, ollowed by adap i e immune esponses i in ec ion pe sis s. Mic oglia, as ocy es,
and o he APCs exp ess Majo His ocompa ibili y Complex (MHC) class II and co-s imula o y molecules, ac i a ing T-
cell sub ypes and s imula ing humo al immune esponses (an ibody p oduc ion by B cells). B lymphocy es eside
p ima ily in he meninges, pa icula ly he du a ma e laye , and gu -sensi ized B cells may con ibu e o CNS humo al
immuni y when pa hogens b each he blood-b ain ba ie [2].
Neu o opism is he abili y o mic oo ganisms o in ade and eside in neu al issue. Neu o opic i uses a y in hei
neu o i ulence and neu oin asi eness; o example, he pes simplex i uses a e highly neu oin asi e bu weakly
neu o i ulen owa d he pe iphe al ne ous sys em. Vi al genomic makeup, biological loca ion, hos immunological
s a e, and en i onmen al ac o s de e mine CNS i al in ec ions. Fla i i us in ec ions a ec speci ic b ain egions like
an e io ho n neu ons, subs an ia nig a, halamus, and neoco ex. Fla i i us neu oin asion is in luenced by en elope
p o ein glycosyla ion, which enhances axonal and ansepi helial anspo , and en y in o hos cells is acili a ed by
a ious cellula a achmen ac o s. Fla i i uses also inc ease BBB pe meabili y by dis up ing igh junc ions. CD8+ T
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 098-115
100
cells a e i al o clea ing Wes Nile i us-in ec ed cells om he CNS. SARS-CoV-2 can en e he CNS ia axonal anspo
h ough c anial ne es o by c ossing he BBB/blood-CSF ba ie a e i emia. Fu u e SARS-CoV-2 a ian s could
exace ba e CNS issues, and immuniza ion may a ec CNS complica ions [2].
Immunosupp essi e E ec s o Pa hogens: Some pa hogens cause immunosupp ession by impeding hemopoiesis o
an igen p esen a ion. Measles i us in ec ion leads o empo a y immunosupp ession, deple ing lymphocy es du ing
acu e in ec ion. Howe e , inc eased adap i e immune esponses e en ually elimina e he i us. HIV p ima ily a ge s
helpe T cells, leading o hei deple ion and Acqui ed Immunode iciency Synd ome (AIDS), and can cause APC
abno mali ies. CMV in ec ion supp esses hemopoiesis, a ec ing bone ma ow s omal cells o di ec ly in ec ing
p ogeni o cells. Measles, HIV, and CMV cause sys emic immunosupp ession h ough a ious mechanisms: al e ing
cy okine equilib ium, impai ing mac ophage and dend i ic cell ac i i ies, inhibi ing hemopoiesis, and gene a ing
immunosupp essi e p o eins. Aspe gillus umiga us, an ai bo ne ungus, causes high mo ali y in immunode icien
pe sons and p oduces glio oxin, which hinde s neu ophil unc ion and inna e immuni y by educing LTB4 o ma ion,
in e e ing wi h neu ophil phagocy ic ac i i ies [2].
In ec ion-Induced Au oimmune Responses: In ec ions can igge au oimmune esponses when he immune sys em
eac s o sel -an igens, o en due o inhe en de iciencies in pe iphe al sel - ole ance, gene ic de ec s, o o he ac o s.
Mul iple scle osis (MS) is a p e alen CNS au oimmune illness. Vi uses o bac e ial in ec ions a e o en he oo causes
o au oimmune diseases, wi h i uses po en ially ini ia ing au oimmune eac ions by in luencing immune cells o sel -
de ense. Molecula mimic y is a basic mechanism by which no mal immune esponses can shi o au oimmune
esponses ollowing an in ec ion [2].
Diagnosis o CNS In ec ions: Diagnosis ypically in ol es clinical p esen a ion, blood es s, blood cul u e and is
con i med by ce eb ospinal luid (CSF) analysis and neu oimaging. Lumba punc u e o CSF analysis is almos always
pe o med when CNS in ec ion is highly suspec ed. Howe e , diagnos ic me hods lack consis en esul s globally, and
a ia ions in s udies exis . Challenges in diagnosing meningi is/encephali is include a ied clinical p esen a ions wi h
o e lapping symp oms such as e e , headache, neck s i ness, al e ed consciousness, seizu es, and ocal neu ological
indings, which can be associa ed wi h di e se in ec ious agen s [3]. Fu he mo e, an e iology is no always iden i ied
due o a lack o a ge ed es ing, he as numbe o po en ial in ec ious causes, and he ac ha abou 10% o suspec ed
cases a e e en ually ound o ha e non-in ec ious o igins. Rou ine CSF pa ame e s can sugges he ype o in ec ion
(bac e ial, i al, o ungal) bu a e no speci ic. Bac e ial meningi is cul u es, while use ul, ake 2–5 days and can yield
alse nega i es due o as idious o ganisms, p io an ibio ic ea men , o imp ope specimen handling. Fo non-
bac e ial ME, clinical suspicion is necessa y o o de he co ec i al agen es ing. Delays in diagnosis and ea men
can occu when labo a o ies, especially in smalle o u al a eas, ely on e e ence labo a o ies o CSF es ing. In Egyp ,
bac e ial sep ic meningi is (73.0%) is p edominan ly caused by S ep ococcus pneumoniae (43.0%), wi h i al sep ic
meningi is (22.0%) p ima ily a ibu ed o HSV (32.8%) and en e o i uses (24.5%) [3].
Clinical P esen a ion and Diagnosis: Pa ien s wi h CNS in ec ions can p esen wi h a ange o symp oms, including
headache, e e , ocal neu ological de ici s, seizu es, acu e con usion, le ha gy, neck pain, pho ophobia, back pain,
nausea, omi ing, syncope, coma, and de ma ological mani es a ions. Cons i u ional symp oms like lymphadenopa hy,
a h algias, and myalgias may also occu .
Meningi is: Acu e meningi is, an in ec ion o he meninges, is he mos common in ec ious disease o he CNS. The
classic iad includes e e , neck s i ness, and al e ed men al s a us, wi h 99–100% o meningi is pa ien s p esen ing
wi h a leas one componen . S. pneumoniae meningi is can lead o apid clinical decline and dea h, al hough
pneumococcal accines ha e educed mo ali y. Lis e ia monocy ogenes should be suspec ed in in an s and elde ly
pa ien s, and Neisse ia meningi idis is conce ning due o i s epidemic po en ial [3].
Encephali is: Pa ien s wi h encephali is can exhibi symp oms anging om sub le de ici s o un esponsi eness,
including neu ological mani es a ions seen in meningi is and seizu es. A hallma k is acu e onse o eb ile illness ( e e
abo e 38°C wi hin 72 hou s). Meningeal symp oms may be absen . Al e ed men a ion can ange om con usion o
ob unda ion. The p esen a ion o en e lec s he causa i e agen 's p edilec ion o ce ain CNS cells; o example, he pes
simplex i us in ec ions a ec ing he empo al lobe can lead o aphasia, anosmia, empo al lobe seizu es, and ocal
neu al de ici s [3].
In conclusion, CNS in ec ions a e a di e se and c i ical g oup o medical condi ions equi ing swi and accu a e
diagnosis and ea men . Thei a ied e iologies, complex immune in e ac ions, and di e se clinical p esen a ions
unde sco e he ongoing challenges in managemen and p e en ion wo ldwide.
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 098-115
101
2. Ma e ials and me hods
• Aim o he wo k: Imp o e clinical managemen and ea men ou come by iden i ying epidemiologic ea u es
and ac o s a ec ing ea men and ou comes.
2.1. Objec i es o he S udy
• To de e mine he mos common causes o cen al ne ous sys em in ec ions.
• To ind ou he ac o s a ec ing clinical managemen and ea men ou come.
• To de e mine he impac o HIV on cen al ne ous sys em in ec ion.
• To know he impac o a elling his o y on cen al ne ous sys em in ec ion.
• To know he e ec o he new me hod o diagnosis o cen al ne ous sys em in ec ion on clinical ou comes.
S udy Design: A desc ip i e e ospec i e s udy.
S udy Se ings: Almaza e e mili a y hospi al.
S udy Popula ion: All pa ien s admi ed o Almaza Fe e Mili a y Hospi al in ensi e ca e uni wi h clinical p esen a ion
sugges ing o a cen al ne ous sys em in ec ion.
Inclusion c i e ia: Pa ien s wi h case de ini ions o cen al ne ous sys em in ec ions in ol ing in ec ion o he b ain
(ce eb um and ce ebellum), spinal co d, op ic ne es, and hei co e ing memb anes. I includes:
• Meningi is: An illness wi h sudden onse o e e (>38.5°C ec al o >38.0°C axilla y) and one o mo e o he
ollowing: neck s i ness, al e ed consciousness, o he meningeal i i a ion signs o pe echial o pu pu eal ash.
• Meningoencephali is: is an in lamma ion o he b ain pa enchyma wi h o wi hou in ol emen o he
meningeal s uc u es.
• Encephali is: is de ined as in lamma ion o he b ain pa enchyma associa ed wi h neu ologic dys unc ion
• Pa asi ic in ec ion o he b ain.
• Pa ien s who included we e admi ed o Almaza Fe e Mili a y Hospi al om July 2021 o Oc obe 2023 and
we e included in he s udy.
• Suspec ed o clinically diagnosed cases in all age g oups would be included.
2.2. Exclusion c i e ia
• All hose pa ien s whose diagnosis was unce ain and inconclusi e we e excluded om he s udy.
• Pa ien s would be excluded om he s udy, like p egnan women and pos - auma ic.
• Pa ien s had con aindica ions o CSF lumba punc u e.
• Pa ien s had incomple e da a eco ds.
2.3. Sample selec ion
All pa ien s admi ed o he in ensi e ca e uni a Almaza Mili a y Fe e Hospi al who me he c i e ia o cen al
ne ous sys em in ec ion in he pe iod om July 2021 o Oc obe 2023.
2.4. Me hods
Regis e ed da a in hospi al da abases and he p ocedu es had been done o all cases included. Regis a ion da a o all
he pa ien s included in he s udy will be e ie ed om hospi al eco ds and collec ed in a p e-p epa ed shee .
2.5. S a is ical Analysis
The collec ed da a will be coded, e ised, and en e ed in o he S a is ical Package o Social Science (IBM SPSS) e sion
20. The da a we e p esen ed as numbe s and pe cen ages o he quali a i e da a, mean, s anda d de ia ions, and anges
o he quan i a i e da a wi h pa ame ic dis ibu ion and median wi h in e qua ile ange (IQR) o he quan i a i e
da a wi h non-pa ame ic dis ibu ion.
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102
3. Resul s
Table 1 Demog aphic da a among s udied pa ien
No
%
Gende
Male
74
71.2%
Female
30
28.8%
Residence
Ru al
39
62.5%
U ban
65
37.5%
Age
Mean ±SD
44.14
20.08
Range
4
82
Median
50
0-18 yea s old
11
10.5%
18-50 yea s old
40
38.46%
O e 50 yea s old
53
50.9%
Mos o he s udied pa ien s (n =74) we e male. The median age o he s udied pa ien s anged om 4 o 82 yea s old
wi h median 50 yea s old; 50.9% (n =53) o all he s udied pa ien s we e o e 50 yea s old. and 10.5% (n =11) o he
s udied pa ien s we e unde 18 yea s old.
Table 2 Medical his o y among s udied pa ien s (n = 104)
No
%
Diabe es
29
27.9%
Hype ension
18
17.3%
T a el his o y o endemic a ea
10
9.6%
U ina y ac in ec ion
8
7.7%
Uppe espi a o y ac in ec ion
5
4.8%
Ischemic hea disease
4
3.8%
HIV
2
1.9%
Pos su gical in e en ion
2
1.9%
Meningi is
2
1.9%
Benign b eas umo excised
1
1.0%
Pa o i is
1
1.0%
Polio
1
1.0%
Righ benign b ain umou
1
1.0%
Hospi al s ay
Mean ±SD
11.77
5.32
Range
2
22
Median
11
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 098-115
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The hospi al s ay du a ion o he s udied pa ien s anged om 2 o 22, wi h median 11. F om he a ious como bidi ies
measu ed. 27.88% o pa ien s (n=29) we e diabe ic, 17.3% (n=18) o pa ien s we e hype ensi e, 3.6% (n=4) o pa ien s
had ischemic hea disease, and 1.9% (n=3) o pa ien s had HIV in ec ions.
Table 3 Suspec ed diagnosis among s udied pa ien s (n = 104)
No
%
Final diagnosis
Encephali is
47
45.2%
Meningi is
43
41.3%
Ce eb al mala ia
10
9.6%
Focal b ain lesion
4
3.9%
F om he inal diagnosis, encephali is was he mos common inal diagnosis ha was ound in 47 pa ien s (45.2%),
ollowed by meningi is, which was ound in 43 pa ien s (41.3%).
Table 4 Cul u e esul s among s udied pa ien s o CSF BioFi e (n = 104)
No
%
Cul u e
No g ow h
60
57.7%
S ep ococcus pneumonia (S pneumonia)
14
13.5%
He ps simplex i us (HSV)
10
9.6%
Posi i e blood ilm o mala ia
10
9.6%
Neisse ia meningi is (N. meningi idis)
2
1.9%
Klebsiella pneumoniae (K. pneumoniae)
2
1.9%
Esche ichia coli (E. coli)
2
1.9%
S aphylococcus au eus (S. au eus)
2
1.9%
C yp ococcus neo o mans (C. neo o mans)
2
1.9%
The esul s we e as ollow:
57.7% (No=60) o s udied pa ien s had unde ec ed e iology. S ep ococcus pneumoniae was he mos commonly
de ec ed, ound in 14 pa ien s (13.5%), ollowed by a posi i e blood ilm o mala ia, which was ound in 10 pa ien s
(9.6%), and he same he pes simplex i us was ound in 10 pa ien s.
Table 5 Main p esen ing symp oms & signs among s udied pa ien s (n = 104)
No
%
Dis u bed conscious le el
Yes
104
100%
Fe e
Yes
94
90.4%
No
10
9.6%
Headache
Yes
65
62.5%
No
39
37.5%
Con ulsion
Yes
32
30.7%
No
72
69.2%
neck igidi y
Yes
27
26%
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 098-115
104
No
77
74%
Vomi ing
Yes
19
18.2%
No
85
81.7%
Fe e
Headache
con ulsion
Vomi ing
Neck igidi y
C. neo o mans
(2)100%
(2)100%
(2)100%
(2)100%
(2)100%
E. coli
(2)100%
(2)100%
(2)100%
HSV
(8)80%
(6)60%
(2)20%
K. pneumoniae
(2)100%
N. meningi idis
(2)100%
(2)100%
S. pneumonia
(14)100%
(12)85.7%
(10)71.4%
(2)14.3%
(8)57.1%
S. au eus
(2)100%
Ce eb al mala ia
100%(10)
70%(7)
30%(3)
10%(1)
%(0)
Unde ec ed
(52)86.7%
(35)65%
(15)25%
(12)20%
(15)25%
X2
103.99
56.027
180.211
126.805
144.595
P alue
0.001
0.001
0.001
0.001
0.001
Dis u bed conscious le el was he main symp om ha was ound in 104 pa ien s (100%), ollowed by e e ha was
ound in 94 pa ien s (90.4%), ollowed by headache ha was ound in 65 pa ien s (62.5%), ollowed by con ulsion ha
was ound in 32 pa ien s (30.7%). Two (100%) pa ien s wi h c yp ococcal meningi is had e e , headache, con ulsion,
omi ing, and neck igidi y. Pa ien s wi h HSV in ec ions: 14 pa ien s (100%) had e e , 12 pa ien s (85.7%) had
headache, 10 pa ien s (71.3%) had con ulsion, 2 pa ien s (14.3%) had omi ing, and 8 pa ien s (57.4%) had neck
igidi y.
Table 6 Glasgow Coma Scale among s udied pa ien s (n = 104)
GCS
Mean
SD
Minimum
Maximum
Median
10.69
2.19
5
14
11
No
%
Abo e 11
49
47.12%
Below 11
55
52.88%
Below 11
11 and o e 11
Meningi is
18
25
41.8%
58.2%
Encephali is
15
32
40%
60%
Focal b ain lesion
2
2
50%
50%
Ce eb al mala ia
6
4
60%
40%
Below 11
11 & o e 11
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 098-115
105
C. neo o mans
(2)100%
E. coli
(2)100%
HSV
(3)30%
(7)70%
K. pneumoniae
(1)50%
(10)50%
N. meningi idis
(2)100%
S. pneumonia
(5)35.6%
(9)64.4%
S. au eus
(2)100%
Unde ec ed
(24)40%
(36)60%
X2
103.99
56.027
P alue
0.001
0.001
The median GCS o he s udied pa ien s anged om 5 o 14, wi h a mean o 10.69 and a median was 11. 52.88% (No=55)
o s udied pa ien s we e below 11. 2 pa ien s (100%) wi h c yp ococcal in ec ion showed GSC below 11; 3 (30%)
pa ien s wi h HSV in ec ion showed GSC below 11; 1 (50%) pa ien wi h Klebsiella in ec ion showed GSC below 11; 10
(50%) pa ien s wi h mala ia in ec ion showed GSC below 11; 5 (35.6%) pa ien s wi h s ep ococcal in ec ion showed
GSC below 11; and 24 (40%) pa ien s wi h unknown in ec ion showed GSC below 11.
Table 7 The esul s o labo a o y in es iga ions among s udied pa ien s (n = 104)
Whi e blood cells (WBC)/
Comple e blood coun (CBC)
Mean
SD
Minimum
Maximum
Median
14.15
9.08
3
56
12
No
%
Abo e 12
45
43.26%
Below 12
59
56.74%
Whi e blood cells/CSF
Mean
SD
Minimum
Maximum
Median
815.74
1685.28
4
10000
135
No
%
Abo e 135
51
49.03%
Below 135
53
50.97%
No
%
COVID swab
No
104
100.0%
WBC in CBC
WBC in CSF
Below 12
12 and o e 12
Below 135
Abo e 135
Meningi is
17
26
10
34
39.5%
60.5%
23.2%
67.85
Encephali is
26
21
31
16
55.3%
44.7%
70%
30%
Focal b ain lesion
4
4
100%
100%
Ce eb al mala ia
7
3
10
0
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 098-115
106
70%
30%
100%
C. neo o mans
0
2
0
2
0
100%
0
100%
E. coli
2
0
0
2
100%
0
0
100%
HSV
8
2
8
2
80%
20%
80%
20%
N. meningi idis
0
2
0
2
0
100%
0
100%
K. pneumoniae
0
2
0
2
0
100%
0
100%
S. pneumoniae
2
12
0
14
14.3%
85.7%
0
100%
S. au eus
2
0
2
0
100%
0
100%
0
Unde ec ed ae iology
29
31
32
28
48.33
51.66%
53.33%
46.66%
Chi Squa e es
X2
35.693
12.968
P alue
0.003
0.113
WBC/CBC o he s udied pa ien s anged om 3 o 56, wi h a mean o 14.15 and a median was 12. 43.26% (No=45) o
s udied pa ien s we e abo e 12. WBC/CSF o he s udied pa ien s anged om 4 o 10000, and 49.03% (N = 51) we e
o e 135. 67.7% o pa ien s wi h meningi is had whi e blood cells in CSF abo e 135, while in encephali is 70% we e
below 135.
2 (100%) pa ien s wi h c yp ococcal in ec ions had ele a ed WBC abo e 12000 in CBC, 2 (20%) pa ien s wi h HSV had
ele a ed WBC abo e 12000 in CBC, 12 (85.7%) pa ien s wi h s ep ococcal in ec ions had ele a ed WBC abo e 12000
in CBC, and 31 (51.6%) pa ien s wi h unknown in ec ions had ele a ed WBC abo e 12000 in CBC.
2 (20%) pa ien s wi h HSV had ele a ed WBC abo e 135 in CSF, 14 (100%) pa ien s wi h s ep ococcal in ec ions had
ele a ed WBC abo e 135 in CSF, and 28 (46.66%) pa ien s wi h unknown in ec ions had ele a ed WBC abo e 135 in
CSF.
Table 8 CT lung and b ain among s udied pa ien s (n = 104)
CT lung
No
%
F ee
83
79.8%
Consolida ion
11
10.5%
Consolida ion+ g ound glass opaci y
6
5.7%
G ound glass opaci y
4
3.9%
CT/ MRI b ain among s udied pa ien s
No
%
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 098-115
113
Vi al pa hogens we e 9.6% and ungal pa hogens we e 1.9% in ou s udy, which was no compa able wi h a s udy
conduc ed in Aus alia [7], which s a ed ha i al pa hogens we e 41.2%, bac e ial 24.1%, and ungal 4.8%.
Unde ec ed e iologies in ou s udy highligh he need o expanded diagnos ics (e.g., mul iplex PCR) o iden i y
i al/a ypical pa hogens.
4.5. T ea men and Ou comes:
Ou s udy used ce iaxone + ancomycin + acyclo i in 57.6% o cases, likely co e ing bo h bac e ial and i al
e iologies. Sab y's s udy used a ious ce iaxone-based egimens, wi h co icos e oids like dexame hasone educing
complica ions. Ou comes in ou s udy show an 80.7% cu e a e and 5.7% mo ali y, while Sab y's s udy [4] epo s
highe mo ali y (28.7% o sep ic meningi is), possibly due o mo e se e e bac e ial cases.
The empi ical use o an i i als (acyclo i ) and an imala ials e lec ed di e se e iologies (encephali is, mala ia) in ou
s udy, while Sab y s a ed co icos e oid use unde sco es bac e ial meningi is managemen guidelines.
Lowe mo ali y in ou s udy migh indica e milde cases o e ec i e empi ical ea men .
Empi ical he apy: Ce iaxone + ancomycin + acyclo i (57.6%) was he mos used egimen, e lec ing adhe ence o
guidelines o bac e ial and i al co e age, which was compa able wi h a s udy in Nepal ha s a ed ha ce iaxone +
ancomycin and an i- ube culous ea men in all TB cases and ano he s udy conduc ed in Laos [12] ha sugges ed
ce iaxone and doxycycline o b oade co e age, possibly due o inc eased icke sial in ec ion incidence.
High comple e cu e a e (80.7%), bu mo ali y (5.7%) occu ed p edominan ly in c yp ococcal (100% a ali y) and
ce eb al mala ia (10%) cases, highligh ing he need o ea ly pa hogen-speci ic in e en ions.
4.6. Mo ali y and Como bidi ies:
The mo ali y a e (5.7%) was lowe han in simila s udies (10–15% an de Beek [9] & 27% India s udy [8]), possibly
due o p omp ICU ca e and empi ical ea men e icacy.
The mo ali y a e (5.7%) was compa able wi h a s udy conduc ed in Aus alia [7], which s a ed ha he mo ali y a e
was 4.4% due o adhe ence o guidelines.
Mo ali y a e: 5.7%, linked o c yp ococcal in ec ions (100% mo ali y), which highligh ed challenges in managing
ungal CNS in ec ions and ce eb al mala ia.
Mo ali y a es in a s udy conduc ed in Laos [12] epo ed 26.3%, and a s udy conduc ed in India [8] epo ed 21%,
which was no compa able wi h ou s udy's 5.7%.
The lowe mo ali y in ou s udy could be due o be e ea men p o ocols, ea lie diagnosis, ea ly empi ical ea men
(e.g., ce iaxone + ancomycin in 57.6% o cases), exclusion o se e e como bidi ies (e.g., only 1.9% HIV co-in ec ion
s. 24.8% in Laos [12]), o di e ences in pa hogen i ulence. Howe e , ou s udy had a smalle sample size, which migh
a ec eliabili y.
All s udies emphasize ea ly in e en ion o educe complica ions.
5. Conclusion
This desc ip i e s udy p o ides a comp ehensi e o e iew o CNS in ec ions managed a a e ia y mili a y hospi al in
Egyp . The indings e eal a dis inc epidemiological p o ile cha ac e ized by an olde pa ien popula ion and a high
bu den o encephali is, con as ing wi h s udies om o he egions whe e bac e ial meningi is domina es younge
coho s. The high a e o unde ec ed e iologies (57.7%) highligh s a signi ican diagnos ic challenge, likely a ibu able
o limi a ions in a ailable mic obiological es ing and possibly p io an ibio ic use.
Despi e his diagnos ic gap, he empi ical ea men s a egy p ima ily employing a combina ion o ce iaxone,
ancomycin, and acyclo i was associa ed wi h a high cu e a e (80.7%) and a ela i ely low o e all mo ali y (5.7%).
Howe e , he 100% mo ali y obse ed in c yp ococcal meningi is cases signals an a ea o u gen imp o emen in he
ea ly ecogni ion and managemen o ungal pa hogens.
GSC Biological and Pha maceu ical Sciences, 2025, 33(01), 098-115
114
The s udy unde sco es se e al key poin s o clinical p ac ice and u u e esea ch:
• Enhanced Diagnos ics: The e is a p essing need o implemen ad anced diagnos ic echniques, such as
mul iplex PCR and CSF an igen es ing, o educe he numbe o cases wi h unknown e iology and allow o
pa hogen-di ec ed he apy.
• Vigilance o Speci ic Pa hogens: Clinicians should main ain a high index o suspicion o he pes simplex i us
encephali is and c yp ococcal meningi is in immunocomp omised pa ien s, ensu ing imely and app op ia e
ea men .
• Age-Speci ic Conside a ions: The p edominance o olde adul s wi h como bidi ies like diabe es sugges s ha
managemen p o ocols should be ailo ed o add ess he complexi ies o his demog aphic.
In conclusion, while empi ical b oad-spec um he apy appea s e ec i e in his se ing, op imizing ou comes o CNS
in ec ions in Egyp hinges on closing he diagnos ic gap. Fu u e e o s should ocus on s eng hening labo a o y
capaci y and conduc ing p ospec i e s udies o be e unde s and he e ol ing epidemiology and op imal managemen
o hese se ious in ec ions.
Compliance wi h e hical s anda ds
Acknowledgmen s
Au ho s wish o hank Majo Gene al Med. Ta ek El Nagdy, manage o he medical mili a y academy, and Majo Gene al
Med. Ash a Zaki, leade o Almaza Mili a y Fe e Hospi al, as well as all s a o Almaza Mili a y Fe e Hospi al.
Disclosu e o con lic o in e es
Au ho s decla e no con lic o in e es o any so
S a emen o e hical app o al
E hical app o al was ob ained om he E hical Commi ee o medical mili a y academy.
S a emen o in o med consen
Consen o ex ac da a om hospi al eco ds ob ained om he Almaza Mili a y Fe e Hospi al adminis a ion. This
da a will no be used o any pu pose o he han his esea ch s udy.
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