Publication date: Mar 22, 2025
Brain infections pose substantial challenges in diagnosis and management and carry high mortality and morbidity, especially in low-income and middle-income countries. We aimed to improve the diagnosis and early management of patients admitted to hospital (adults aged 16 years and older and children aged >28 days) with suspected acute brain infections at 13 hospitals in Brazil, India, and Malawi. With hospital stakeholders, policy makers, and patient and public representatives, we co-designed a multifaceted clinical and laboratory intervention, informed by an evaluation of routine practice. The intervention, tailored for each setting, included a diagnostic and management algorithm, a lumbar puncture pack, a testing panel, and staff training. We used multivariable logistic regression and interrupted time series analysis to compare the coprimary outcomes-the percentage of patients achieving a syndromic diagnosis and the percentage achieving a microbiological diagnosis before and after the intervention. The study was registered at ClinicalTrials. gov (NCT04190303) and is complete. Between Jan 5, 2021, and Nov 30, 2022, we screened 10 462 patients and enrolled a total of 2233 patients at 13 hospital sites connected to the four study centres in Brazil, India, and Malawi. 1376 (62%) were recruited before the intervention and 857 (38%) were recruited after the intervention. 2154 patients (96%) had assessment of the primary outcome (1330 [62%] patients recruited pre-intervention and 824 [38%] recruited post-intervention). The median age across centres was 23 years (IQR 6-44), with 1276 (59%) being adults aged 16 years or older and 888 (41%) children aged between 29 days and 15 years; 1264 (59%) patients were male and 890 (41%) were female. Data on race and ethnicity were not recorded. 1020 (77%) of 1320 patients received a syndromic diagnosis before the intervention, rising to 701 (86%) of 813 after the intervention (adjusted odds ratio [aOR] 1.81 [95% CI 1.40-2.34]; p
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| Concepts | Keywords |
|---|---|
| Brazil | Acute Disease |
| Clinicaltrials | Adolescent |
| High | Adult |
| Nct04190303 | Brazil |
| Child | |
| Child, Preschool | |
| Female | |
| Hospitalization | |
| Humans | |
| India | |
| Infant | |
| Malawi | |
| Male | |
| Young Adult |
Semantics
| Type | Source | Name |
|---|---|---|
| disease | IDO | intervention |
| disease | MESH | infections |
| disease | MESH | morbidity |
| disease | IDO | algorithm |
| drug | DRUGBANK | Etoperidone |
| drug | DRUGBANK | Coenzyme M |
| disease | IDO | infection |
| disease | MESH | Zoonotic Infections |
| disease | MESH | Infectious Diseases |
| disease | MESH | Acute Disease |