Improving brain infection diagnostics in India

By Dr Angel T Miraclin India (Vellore Centre) Co-Investigator, Brain Infections Global Intervention Study Associate Professor, Neurology, Christian Medical College & Hospital, Vellore, India. To view the full paper click here (external link).

Brain infections remain a major cause of illness and death, requiring timely and accurate diagnosis for effective treatment. In India, the healthcare landscape presents a unique challenge: large tertiary hospitals have access to advanced diagnostic tools and structured processes, while smaller hospitals—often the first point of care—lack these resources. Recognising this, we implemented a set of interventions tailored to improve brain infection diagnosis and management across a wide variety of healthcare settings.

A key objective of our study was to strengthen existing processes in tertiary hospitals while simultaneously introducing essential diagnostic tools and workflows in smaller hospitals. By doing so, we ensured that freely available tools and protocols could be adapted to different healthcare environments, making a tangible impact across the spectrum of care in India.

Key Findings and Interventions

Our study significantly improved the detection of a wide range of brain infections. We diagnosed a greater number of cases of scrub typhus and dengue—important but often under-recognised causes of brain infections in India.

We also improved the identification of Streptococcus pneumoniae and several viruses that were previously undetected, including Chikungunya, JC virus and Enterovirus. Additionally, we facilitated the sharing of tests for rabies and other less common but critical pathogens between laboratories, ensuring more comprehensive diagnostic capabilities.

To address variability in diagnostic capacity, we implemented targeted interventions, including:

• Process optimization in tertiary hospitals: We worked within established systems to enhance existing workflows, ensuring that diagnostic tests were performed promptly and appropriately interpreted. Testing for region specific pathogens were prioritised, which was cost effective and useful.
• Strengthening smaller hospitals: We introduced simple but effective diagnostic protocols to improve early recognition and referral of suspected brain infections. Guidance was provided on empirical therapy according to the syndromic diagnosis, hence modifying the outcomes.
• Improving laboratory collaboration: We encouraged test-sharing between institutions, allowing better access to specialised diagnostics across different settings. Small hospitals often outsource samples, which are expensive. The extension of laboratory support to these small hospitals proved useful, and cost effective.
• Capacity building: We trained healthcare professionals at all levels in improved sample collection, test interpretation, and evidence-based management strategies. The intervention not only trained the physicians, but an equal attention was paid to the nurses and laboratory personnel which improved the diagnostic rates and effective management.

Impact and Future Directions

India contributed the majority of patients to this study, with its hospitals playing a central role in shaping our overall findings. The results are now actively informing national brain infection guidelines, developed by leading neurologists, infectious diseases specialists, and microbiologists. By integrating these findings into national protocols, we are ensuring that our study has a lasting impact on clinical practice, influencing treatment strategies for years to come.

Furthermore, training physicians in diagnosis and management of brain infections, and establishing a training programme is paramount to sustain the gains from the project. An India-focused adaptation of the ‘Neuro-ID Course’, held annually at the University of Liverpool, was conducted in India for the third time this year in February 2025. This was organised jointly by the team at Christian Medical College, Vellore and NIMHANS, Bangalore (the two main Brain Infections Global partner institutions) to coincide with World Encephalitis Day. This included interactive sessions led by experts in public health, infectious diseases, case discussions by less senior clinicians and a quiz.

Going forward, our focus will be on expanding these efforts, refining best practices, and working closely with policymakers to ensure continued improvements in brain infection management across India. This study highlights the power of adapting interventions to local contexts, demonstrating that effective, scalable solutions can bridge gaps between high-resource and low-resource settings within the same country.