Tuberculous Meningitis Remains Most Common CNS Infection in Philippine Adults
A retrospective study of 184 adults with central nervous system infections in the Philippines found tuberculous meningitis as the leading cause. Common symptoms included fever, headache, and neurologic deficits; CSF culture yield was just 25%. Findings call for updated local guidelines amid rising antimicrobial resistance.
A retrospective study of 184 adult patients with central nervous system infections (CNSI) at a single Philippine institution found that tuberculous (TB) meningitis is the most common type, with fever, headache, and neurologic deficits being the predominant presenting manifestations.
The study, conducted from January 2017 to December 2024, reviewed 357 charts and included 184 patients meeting criteria. The most common symptoms were fever (64.7%), headache (43.5%), and neurologic deficits (36.4%). Cerebrospinal fluid (CSF) analysis showed elevated opening pressures (≥20 cm H₂O), lymphocytic pleocytosis, elevated protein (≥50 mg/dL), and hypoglycorrhachia (CSF/serum glucose ratio ≤0.5) in the majority of patients. However, microbiologic CSF analysis had a low positivity rate of only 25%, with a mixture of bacterial, fungal, viral, and parasitic agents identified.
Factors such as early antibiotic initiation and fastidious organisms were cited as reasons for the low culture yield. Not all patients displayed classic CSF pleocytosis or hypoglycorrhachia; possible explanations include an ineffective immune response in immunocompromised patients or early CSF collection before an inflammatory response has occurred.
The findings, presented as a poster abstract at the 47th Philippine Society for Microbiology and Infectious Diseases (PSMID) Annual Convention in 2025, highlight the need for updated local data. Current guidelines from the Infectious Diseases Society of America (IDSA) for bacterial meningitis were published in 2004 and may no longer be accurate due to ongoing antimicrobial resistance and a lack of local epidemiological data. In the Philippines, TB meningitis and bacterial meningitis remain the top two causes of CNSI, with roughly 10.5 million people afflicted annually across Southeast Asia. The study underscores the importance of prompt antibiotic therapy given that delayed lumbar puncture or drainage is inevitable in some cases, aiming to reduce morbidity and mortality.