Epidemiology of central nervous system infectious diseases: a meta-analysis and systematic review with implications for neurosurgeons worldwide
Abstract
OBJECTIVE: Central nervous system (CNS) infections cause significant morbidity and mortality and often require neurosurgical intervention for proper diagnosis and treatment. However, neither the international burden of CNS infection, nor the current capacity of the neurosurgical workforce to treat these diseases is well characterized. The objective of this study was to elucidate the global incidence of surgically relevant CNS infection, highlighting geographic areas for targeted improvement in neurosurgical capacity. METHODS: A systematic literature review and meta-analysis were performed to capture studies published between 1990 and 2016. PubMed, EMBASE, and Cochrane databases were searched using variations of terms relating to CNS infection and epidemiology (incidence, prevalence, burden, case fatality, etc.). To deliver a geographic breakdown of disease, results were pooled using the random-effects model and stratified by WHO region and national income status for the different CNS infection types. RESULTS: The search yielded 10,906 studies, 154 of which were used in the final qualitative analysis. A meta-analysis was performed to compute disease incidence by using data extracted from 71 of the 154 studies. The remaining 83 studies were excluded from the quantitative analysis because they did not report incidence. A total of 508,078 cases of CNS infections across all studies were included, with a total sample size of 130,681,681 individuals. Mean patient age was 35.8 years (range: newborn to 95 years), and the male/female ratio was 1:1.74. Among the 71 studies with incidence data, 39 were based in high-income countries, 25 in middle-income countries, and 7 in low-income countries. The pooled incidence of studied CNS infections was consistently highest in low-income countries, followed by middle- and then high-income countries. Regarding WHO regions, Africa had the highest pooled incidence of bacterial meningitis (65 cases/100,000 people), neurocysticercosis (650/100,000), and tuberculous spondylodiscitis (55/100,000), whereas Southeast Asia had the highest pooled incidence of intracranial abscess (49/100,000), and Europe had the highest pooled incidence of nontuberculous vertebral spondylodiscitis (5/100,000). Overall, few articles reported data on deaths associated with infection. The limited case fatality data revealed the highest case fatality for tuberculous meningitis/spondylodiscitis (21.1%) and the lowest for neurocysticercosis (5.5%). In all five disease categories, funnel plots assessing for publication bias were asymmetrical and suggested that the results may underestimate the incidence of disease. CONCLUSIONS: This systematic review and meta-analysis approximates the global incidence of neurosurgically relevant infectious diseases. These results underscore the disproportionate burden of CNS infections in the developing world, where there is a tremendous demand to provide training and resources for high-quality neurosurgical care.
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Mycobacterium tuberculosis is a major cause of childhood CNS infection in tuberculosis endemic areas such as Uganda.
“Another microorganism not targeted by FA-ME is Mycobacterium tuberculosis, despite it being a major cause of childhood CNS infection in tuberculosis endemic areas such as Uganda [6, 20].”
From Clinical utility of the FilmArray® meningitis/encephalitis panel in children with suspected central nervous system infection in a low-resource setting – a prospective study in Southwestern Uganda (2025) · cites this paper as [6]
The Results (page unavailable) identify tuberculosis-related CNS disease and report a high incidence of tuberculous spondylodiscitis in Africa. They do not establish that Mycobacterium tuberculosis is a major cause of childhood CNS infection in Uganda or other tuberculosis-endemic areas. (LLM, conf=0.76)
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Research works printed but not linked: 11
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- [14][14] Dewan, Michael C., Rattani, Abbas, Fieggen, Graham, Arraez, Miguel A., Servadei, Franco, Boop, Frederick A., Johnson, Walter D., Warf, Benjamin C., and Park, Kee B., 2018, "Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care. Executive Summary of the Global Neurosurgery Initiative at the Program in Global Surgery and Social Change" Journal of Neurosurgery pp 1, 1933-0693 Crossref Metrics All Time Past Year Past 30 Days Abstract Views 5767 320 68 Full Text Views 8669 7 1 PDF Downloads 5621 9 1 EPUB Downloads 0 0 0 PubMed Citation Articles by Faith C. Robertson Articles by Jacob R. Lepard Articles by Rania A. Mekary Articles by Matthew C. Davis Articles by Ismaeel Yunusa Articles by William B. Gormley Articles by Ronnie E. Baticulon Articles by Muhammad Raji Mahmud Articles by Basant K. Misra Articles by Abbas Rattani Articles by Michael C. Dewan Articles by Kee B. Park Similar articles in PubMed Article by Faith C. Robertson Article by Jacob R. Lepard Article by Rania A. Mekary Article by Matthew C. Davis Article by Ismaeel Yunusa Article by William B. Gormley Article by Ronnie E. Baticulon Article by Muhammad Raji Mahmud Article by Basant K. Misra Article by Abbas Rattani Article by Michael C. Dewan Article by Kee B. Park Similar articles in Google Scholar AANS logo © Copyright 1944-2026 American Association of Neurological Surgeons. All rights reserved, including those for text and data mining, AI training, and similar technologies. Permissions Legal Notices Feedback Editorial Boards CME For Advertisers Job Seekers JNSPG Shop Facebook Twitter Instagram Powered by PubFactory Powered by PubFactory [32.199.175.127] 32.199.175.127 Close Posted by 36 X users On 1 Facebook pages
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Dewan, M. C., Rattani, A., Fieggen, G. A. G., Arráez, M. Á. E., Servadei, F., Boop, F. A., Johnson, W. D., Warf, B. C., & Park, K. B. (2018) · Journal of neurosurgery · doi:10.3171/2017.11.jns171500 · Cited by 649 · see citing works
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Viral and Prion Infections Associated with Central Nervous System Syndromes in Brazil
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Matrix metalloproteinase-9 (MMP-9): A macromolecular mediator in CNS infections: A review
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Antibacterial action mechanisms and mode of trypsin inhibitors: a systematic review
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Diagnostic Model for Discrimination Between Tuberculous Meningitis and Bacterial Meningitis
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Astrocytes in the pathophysiology of neuroinfection
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Management of infective complications of otitis media in resource-constrained settings
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The Neurosurgical Workforce of the Philippines
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Balamuthia mandrillaris Granulomatous Amoebic Encephalitis: The First African Experience
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Spectrum of central nervous system infections in a tertiary health care centre in Cameroon
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The Next Frontier in Neurocritical Care in Resource-Constrained Settings
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A case of meningitis caused by Ralstonia insidiosa, a rare opportunistic pathogen
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Editorial. Global neurosurgery and our social responsibility
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“Annually, 2.9 million cases of bacterial meningitis occur worldwide, with a disproportionally higher incidence in low-income countries [6].”
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Lumbar Puncture: Indications, Challenges and Recent Advances
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PET-CT in brain disorders: The South African context
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Pediatric central nervous system infections in the Amazon: clinical and laboratory profiles
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Pentraxin 3: a novel biomarker in pediatric central nervous system infections
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Prevotella oris-caused meningitis and spinal canal infection: A case report
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The Power of Advocacy in Global Neurosurgery
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Diagnostic Challenges and Dilemmas in Tuberculous Meningitis
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- Authors
- Robertson, F. C., Lepard, J. R., Mekary, R. A., Davis, M. C., Yunusa, I., Gormley, W. B., Baticulon, R. E., Mahmud, M. R., Misra, B. K., Rattani, A., Dewan, M. C., & Park, K. B.
- Affiliations
- Brigham and Women's Hospital (US)
- University of Alabama at Birmingham (US)
- Philippine General Hospital (PH)
- National Hospital Abuja (NG)
- P. D. Hinduja Hospital and Medical Research Centre (IN)
- Meharry Medical College (US)
- Harvard University (US)
- ORCID
- Venue
- Journal of Neurosurgery
- Published
- 2019-04
- Volume
- 130
- Issue
- 4
- Pages
- 1107-1126
- ISSN
- 0022-3085 (ISSN-L)
- 1933-0693
- OpenAlex
- W2808228286
- Cited by
- 116
- References
- 190
- Citations by year
- 2026: 14 · 2025: 15 · 2024: 14 · 2023: 21 · 2022: 14 · 2021: 16 · 2020: 13 · 2019: 6 · 2018: 3
- FWCI
- 1.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of neurosurgery (publishedVersion)
- PubMed (publishedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Funders
- Congress of Neurological Surgeons
- Vanderbilt University
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Surgery
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Keywords
- central nervous system infection, incidence, global burden of disease, neurosurgical workforce, bacterial meningitis, neurocysticercosis, tuberculous spondylodiscitis, intracranial abscess, case fatality, WHO regions, low-income countries, neurosurgical training
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