Epidemiological trends and neurological outcomes of pediatric central nervous system infections in rural part of western India

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.