Publication:

Clinical profile, etiology and outcomes of meningoencephalitis in a tertiary care centre in Kerala

Background Meningoencephalitis remains a serious public-health issue in many low- and middle-income countries due to its potential for rapid neurological deterioration and preventable mortality. Limited diagnostic tools at peripheral hospitals often lead to delayed referral and empirical treatment. Understanding the regional etiology and identifying predictors of poor outcomes are essential for early case recognition, prioritisation of high-risk patients and strengthening surveillance and diagnostic pathways.

Methods A prospective observational study was conducted among 129 patients (>13 years) admitted with meningoencephalitis to Government Medical College, Kozhikode from January 2019 to June 2020. Clinical features and CSF serological/molecular diagnostics were analysed. Patient outcomes at discharge were recorded and compared across etiological categories.

Results Among 129 patients, 56% were male and 61% were aged <40 years. Common symptoms were fever (96%), headache (86%), vomiting (64%), altered sensorium (53%) and seizures (34%). Etiology was identified in 39.5%, with viral meningoencephalitis most common; HSV-1 was the leading viral agent. ICU care was required in 24.8% and ventilatory support in 7%. Overall, 83.7% recovered completely, 6.2% had sequelae and 10.1% died. Mortality was highest in tuberculous and fungal meningitis. Seizures, low GCS and delayed presentation were associated with poor outcomes.

Conclusions Viral meningoencephalitis was the leading etiology, while tuberculous and fungal infections contributed disproportionately to mortality. Improved access to molecular diagnostics and early recognition of high-risk clinical indicators could reduce preventable deaths. Strengthening surveillance and referral pathways is essential to improving neurological outcomes in the community.