Introduction: Central nervous system (CNS) infections cause significant morbidity and mortality, and often require neurosurgical intervention for proper diagnosis and treatment. 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 relating to CNS infection and epidemiology published between 1990 and 2016 in PubMed, EMBASE, and Cochrane databases The search resulted in 10,906 studies, 154 of which were used in the final qualitative analysis, and 81in the quantitative meta-analysis. Results were pooled using the random-effects model and stratified by WHO region and national income status for five CNS infection types.
Results: A total of 508,078 cases of CNS infections were included, with a sample size of 130,681,681individuals. Mean age was 35.8 years (range: newborn to 95). The male:female ratio was 1:1.74. Of 81 studies with incidence data, 40 were based in high-income countries, 45 in middle-income countries, and 8 in low-income countries. The pooled incidence of studied CNS infections was consistently highest in low-income, followed by middle- and then high-income countries. Regarding WHO regions, Africa had the highest pooled incidence of bacterial meningitis (65/100,000), neurocysticercosis (650/100,000) and tuberculous spondylodiscitis (55/100,000), while Southeast Asia had the highest pooled incidence of intracranial abscess (49/100,000). Europe had the highest pooled incidence of non-tuberculous vertebral spondylodiscitis (5/100,000). Overall, few articles reported mortality data, but limited case fatality information revealed the highest case fatality for tuberculous meningitis/spondylodiscitis (21.5%), and the lowest reported average for neurocysticercosis (5.5%). Funnel plots assessing publication bias suggested our results may underestimate the incidence of disease.
Conclusions: These results underscore the disproportional burden of CNS infections in the developing world, where there is a tremendous demand to provide training and resources for high quality neurosurgical care.
Patient Care: The data described in this study likely reflect realistic trends observed worldwide, and this study therefore provides the neurosurgical community with an accurate and inclusive estimate to date of the global incidence of central nervous system infectious disease, so that we may work together to tackle this health disparity.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the disproportional burden of CNS infections in the developing world, 2) Discuss how case fatality may also be reflective of surgical and technical capacity, and 3) Discuss, in small groups, how we can begin to address the discordance between burden and surgical capacity