Peer-reviewed article
Epidemiological trends and neurological outcomes of pediatric central nervous system infections in rural part of western India.
Pushparaj Nilkanth Patil, Zubair Khan, Darshankumar K Mahyavanshi ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined 278 children aged 1 month to 12 years admitted to a rural hospital in western India with central nervous system infections between 2021 and 2025. Viral encephalitis was the most common cause (39.9%), followed by bacterial meningitis (30.9%) and tuberculosis meningitis (15.1%). Overall mortality was 9.4%, but varied by infection type, with tuberculosis meningitis having the highest death rate at 21.4%. The study found that bacterial meningitis cases have declined over time while viral encephalitis cases have increased.
Key points
- Viral encephalitis is now the leading cause of CNS infections in rural western India (39.9%), surpassing bacterial meningitis (30.9%)
- Overall mortality was 9.4%, with tuberculosis meningitis having the highest mortality at 21.4%, followed by bacterial meningitis at 12.8%
- Neurological sequelae occurred in 14% of children, predominantly after tuberculosis meningitis and bacterial meningitis
- Children under 5 years old were significantly more likely to have poor outcomes (P = 0.03)
- Seasonal clustering was observed during monsoon and post-monsoon months, accounting for 41.7% of cases
Limitations
This is a retrospective study from a single rural hospital in western India, so findings may not generalise to urban settings or other Indian regions with different vaccination coverage and healthcare access. The study describes epidemiological patterns and outcomes but does not evaluate any specific intervention.
Abstract
BACKGROUND: Central nervous system (CNS) infections remain a leading cause of morbidity, mortality, and disability among children in low-income and middle-income countries. In India, regional variations in etiology and outcomes are influenced by vaccination uptake, environmental conditions, and healthcare access. Data from rural western India remains limited. AIM: To evaluate the epidemiological trends, clinical spectrum, etiological distribution, and short-term outcomes of pediatric CNS infections, and to identify factors associated with adverse neurological outcomes. METHODS: This retrospective study included 278 children (1 month to 12 years) admitted with CNS infections between January 2021 and April 2025. Cases were classified as bacterial meningitis, viral encephalitis, tuberculous meningitis (TBM), brain abscess, or undetermined etiology, based on clinical, laboratory, and neuroimaging criteria. Outcomes were categorized as recovery, neurological sequelae, or death. Data were analyzed for demographic distribution, seasonal patterns, and temporal trends. RESULTS: The mean age was 5.8 years; 51.1% were < 5 years old, and males accounted for 58.3%. Viral encephalitis was the leading etiology (39.9%), followed by bacterial meningitis (30.9%), TBM (15.1%), brain abscess (2.2%), and undetermined (11.9%). Seasonal clustering occurred during monsoon/post-monsoon months (41.7%). Mortality was 9.4% overall, highest in TBM (21.4%) and bacterial meningitis (12.8%), while viral encephalitis had the lowest (2.7%). Neurological sequelae affected 14.0% of children, predominantly after TBM and bacterial meningitis. Over time, bacterial meningitis declined (31%-21%), while viral encephalitis increased (34%-42%). Children aged < 5 years were more likely to have poor outcomes (P = 0.03). Mortality was highest in TBM (21.4%, P = 0.01), followed by bacterial meningitis (11.4%). CONCLUSION: Pediatric CNS infections in rural India show shifting trends, with viral encephalitis surpassing bacterial meningitis. Strengthening vaccination coverage, early diagnosis, and hospital preparedness can reduce morbidity and mortality associated with pediatric CNS infection.