Neuro-infections

Expert management of TB meningitis, viral encephalitis, brain abscess, and other CNS infections with systemic involvement by Dr. Chetan Padghan in Pune.

Understanding Neuro-infections

Neuro-infections are infections that affect the brain, spinal cord, or the surrounding membranes (meninges). These conditions can range from mild to life-threatening and require prompt diagnosis and treatment. In India, neuro-infections are a significant cause of neurological morbidity, with tuberculosis (TB) being one of the most common causes.

Dr. Chetan Padghan has extensive experience in diagnosing and managing the full spectrum of central nervous system (CNS) infections encountered in clinical practice.

Types of Neuro-infections

Meningitis

Inflammation of the meninges (protective membranes covering the brain and spinal cord):

Bacterial meningitis — caused by bacteria such as Streptococcus pneumoniae, Neisseria meningitidis, or Listeria; requires emergency antibiotic treatment
Tubercular (TB) meningitis — a major cause of meningitis in India; requires prolonged anti-tubercular therapy
Viral meningitis — usually milder; caused by enteroviruses, herpes viruses, and others
Fungal meningitis — cryptococcal meningitis in immunocompromised patients
Chronic meningitis — persistent meningeal inflammation lasting weeks to months

Encephalitis

Inflammation of the brain tissue itself:

Herpes simplex encephalitis (HSE) — the most common cause of sporadic encephalitis; requires urgent antiviral treatment with acyclovir
Japanese encephalitis — endemic in parts of India; transmitted by mosquitoes
Autoimmune encephalitis — immune-mediated brain inflammation that can mimic infectious encephalitis
Post-infectious encephalitis — brain inflammation following a systemic infection

Brain Abscess

A collection of pus within the brain:

Can arise from direct spread (ear, sinus, or dental infections), blood-borne spread, or post-surgical/post-traumatic causes
Presents with headache, fever, focal neurological deficits, and seizures
Requires antibiotics and often surgical drainage

Other CNS Infections

Neurocysticercosis — brain infection caused by the larval stage of the pork tapeworm; a leading cause of epilepsy in developing countries
Cerebral malaria — severe malaria affecting the brain
Spinal infections — spinal epidural abscess, tubercular spondylitis (Pott’s spine)
HIV-related neurological infections — toxoplasmosis, progressive multifocal leukoencephalopathy (PML), CMV encephalitis

Tubercular (TB) Meningitis — A Special Focus

TB meningitis remains one of the most devastating forms of tuberculosis. In India, it is particularly prevalent and requires a high index of suspicion.

Clinical Features

Subacute onset of headache, fever, and neck stiffness
Progressive confusion and altered consciousness
Cranial nerve palsies (especially affecting eye movements)
Seizures and focal neurological deficits
Hydrocephalus (accumulation of fluid in the brain)

Diagnosis

CSF analysis — elevated protein, low glucose, lymphocytic pleocytosis
CSF TB PCR (GeneXpert) and culture
Brain MRI — meningeal enhancement, hydrocephalus, tuberculomas, infarcts
Chest X-ray and systemic TB workup

Treatment

Prolonged anti-tubercular therapy (ATT) — typically 9 to 12 months
Corticosteroids to reduce inflammation and improve outcomes
Management of hydrocephalus — medical or surgical (VP shunt)
Monitoring for drug side effects and treatment response
Rehabilitation for neurological sequelae

Diagnostic Approach

Clinical Assessment

Detailed history including fever pattern, recent infections, travel, animal exposure, and immune status
Thorough neurological examination
Assessment of meningeal signs — neck stiffness, Kernig’s sign, Brudzinski’s sign

Investigations

Lumbar puncture & CSF analysis — the cornerstone of diagnosis; includes cell count, protein, glucose, Gram stain, culture, PCR
Brain MRI with contrast — to identify meningeal enhancement, brain abscess, encephalitis, hydrocephalus
CT brain — often the initial imaging, especially in emergency settings
Blood investigations — complete blood count, inflammatory markers (CRP, ESR, procalcitonin), blood cultures
Specific tests — GeneXpert for TB, viral PCR panels, cryptococcal antigen, autoimmune encephalitis antibody panels

Treatment Approach

Acute Management

Empiric antibiotic/antiviral therapy initiated without delay when meningitis or encephalitis is suspected
ICU care for patients with altered consciousness or respiratory compromise
Seizure management
Intracranial pressure management
Correction of metabolic derangements

Specific Therapies

Bacterial meningitis — targeted antibiotics based on culture and sensitivity, with dexamethasone
TB meningitis — anti-tubercular therapy with corticosteroids
Herpes encephalitis — intravenous acyclovir for 14–21 days
Brain abscess — prolonged antibiotics, surgical drainage if indicated
Neurocysticercosis — antiparasitic therapy with corticosteroids, anti-seizure medications
Fungal infections — antifungal therapy (amphotericin B, fluconazole)

Recovery & Follow-up

Serial neurological assessments and imaging to monitor treatment response
Rehabilitation for motor, cognitive, and speech deficits
Seizure prevention and management
Hearing assessment (especially after bacterial meningitis)
Long-term follow-up for complications and sequelae

When to Seek Urgent Care

Fever with severe headache and neck stiffness
Fever with confusion, drowsiness, or behavioral changes
New-onset seizures with fever
Progressive weakness or neurological symptoms with fever
Altered consciousness following a recent infection

Dr. Chetan Padghan provides expert care for all types of neuro-infections in Pune. If you or a loved one is experiencing neurological symptoms associated with fever or infection, seek prompt neurological consultation.