Community-Acquired CNS Infections in Western Asia (2010–2025): A Systematic Review

Background / Objective: This systematic review aimed to summarize the epidemiology, etiology, diagnostic challenges, antimicrobial resistance, and clinical outcomes of community-acquired central nervous system (CNS) infections in Western Asian countries. METHODS: A systematic search of PubMed was conducted for studies published from January 2010 to July 2025. Eligible studies included original research and case reports on CNS infections, while unrelated studies or studies outside Western Asia were excluded. Data were extracted and synthesized narratively by pathogen group. Risk of bias was assessed based on study design, sample size, and methodological quality. RESULTS: Of 1,790 retrieved articles, 450 studies met the inclusion criteria, including case reports and observational studies across neonates, children, and adults. Streptococcus pneumoniae and Neisseria meningitidis were the most common bacterial pathogens; Listeria monocytogenes and multidrug-resistant Gram-negative organisms were notable. Among viral pathogens, Enteroviruses, herpes simplex virus type 1, and West Nile virus predominated, with increasing reports of post-COVID-19 autoimmune encephalitis. Tuberculous meningitis and neurobrucellosis remained significant causes of chronic CNS infections in endemic areas. Pneumococcal penicillin resistance exceeded 40% in some countries. Molecular diagnostic capacity and surveillance were limited. LIMITATIONS: Evidence was limited by heterogeneity in study design, regional data gaps, and variable reporting of antimicrobial resistance, which may affect the comprehensiveness of the review. Conclusions / Interpretation: Community-acquired CNS infections continue to impose a substantial health burden in Western Asia. Expanded vaccination, improved molecular diagnostics, strengthened surveillance, and regional antimicrobial resistance monitoring are essential to reduce preventable mortality and long-term neurological sequelae.