The DOI matches its Crossref record; 190 of the 190 references it cites were found in a registry or an index.
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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“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]
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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
Self-citationPediatric neurosurgical workforce, access to care, equipment and training needs worldwide
Dewan, M. C., Baticulon, R. E., Rattani, A., Johnston, J. M., Warf, B. C., & Harkness, W. F. J. (2018) · Neurosurgical FOCUS · doi:10.3171/2018.7.focus18272 · Cited by 111
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The impact of African-trained neurosurgeons on sub-Saharan Africa
Karekezi, C., Khamlichi, A. E., Ouahabi, A. E., Abbadi, N. E., Ahokpossi, S., Ahanogbe, K. M. H., Berete, I., Bouya, S. M., Coulibaly, O., Dao, I., et al. (2020) · Neurosurgical FOCUS · doi:10.3171/2019.12.focus19853 · Cited by 80
Immunity Against Bacterial Infection of the Central Nervous System: An Astrocyte Perspective
Geyer, S., Jacobs, M., & Hsu, N. (2019) · Frontiers in Molecular Neuroscience · doi:10.3389/fnmol.2019.00057 · Cited by 68
Metadata
- 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
- 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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