What was the Brain Infections Global (BI Global) study?
Brain Infections Global – an NIHR Global Health Research Group improving the management of acute brain infections.
University of Liverpool researchers have worked with global partners to identify and implement an intervention package that has significantly improved the diagnosis and management of brain infections in hospitals across Brazil, India, and Malawi.
The study, published in The Lancet March 2025, was coordinated by researchers at the University of Liverpool in collaboration with international partners and implemented across 13 hospitals in three low- and middle-income countries. The lead centres were the Oswaldo Cruz Foundation (Fiocruz), Recife, Brazil; National Institute of Mental Health and Neuro Sciences, Bangalore, India; Christian Medical College, Vellore, India; and Malawi-Liverpool-Wellcome Trust Clinical Research Programme and Kamuzu University of Health Sciences in Blantyre, Malawi.
The intervention included: clinical diagnosis and management algorithm to guide healthcare providers, a lumbar puncture support pack to facilitate crucial procedures, a panel of laboratory tests to enhance diagnostic accuracy and training for hospital staff to strengthen the implementation of these tools.
The proportion of patients receiving a syndromic diagnosis (confirming they had a brain infection) increased from 77% to 86%, while the microbiological diagnosis rate (identifying the exact pathogen) rose from 22% to 30%. In addition to improving diagnosis, the intervention enhanced the performance of lumbar punctures, optimized initial treatment, and improved patients’ functional recovery after illness.
Learn more about the study from The Encephalitis Podcast episode 47 with Dr Bhagteshwar Singh!
How was Encephalitis International involved?
EI played a vital role in the project, spearheading the patient, public and community engagement and involvement (PPCEI) element of the study. Central to this was the PPCEI panel, a multi-disciplinary team that included patients/patients’ caregivers and patient advocates, each bringing different perspectives, experience and knowledge to the research programmes.
The panel, chaired by EI’s CEO Dr Ava Easton, met on a six-monthly basis, and more often if needed. The panel was faced with challenges such as the COVID-19 pandemic, but adapted to this with great success, holding the meetings online to ensure that the patient voice were still heard. Significantly, there was a patient/caregiver representative from each centre in Brazil, India and Malawi, and from the UK.
The panel began as the BIGlobal patient & public involvement (PPI) panel in 2018; when the COVID-Neuro Global programme was funded in 2020, this expanded to include patient/professional representatives from a broader range of diseases, including stroke.
The PPCEI panel has contributed widely throughout the duration of the programmes, starting with initial design of study data collection and consent forms. Meetings in March-April 2022 enabled the panel to provide input into brain infection training, and the setup of Brain Infection Champions to promote implementation and sustainability of the BIGlobal intervention.
Hear more about the PPCEI aspect of the project from The Encephalitis Podcast episode 46 with Dr Ava Easton!