{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T13:31:31Z","timestamp":1770039091443,"version":"3.49.0"},"reference-count":68,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2022,3,21]],"date-time":"2022-03-21T00:00:00Z","timestamp":1647820800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>The epidemiology of central nervous system (CNS) infections in tropical Australia is incompletely defined.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>A retrospective study of all individuals in Far North Queensland, tropical Australia, who were diagnosed with a CNS infection between January 1, 2000, and December 31, 2019. The microbiological aetiology of the infection was correlated with patients\u2019 demographic characteristics and their clinical course.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>There were 725 cases of CNS infection during the study period, meningitis (77.4%) was the most common, followed by brain abscess (11.6%), encephalitis (9.9%) and spinal infection (1.1%). Infants (24.3%, p&lt;0.0001) and Aboriginal and Torres Strait Islander Australians (175\/666 local residents, 26.3%, p&lt;0.0001) were over-represented in the cohort.<\/jats:p><jats:p>A pathogen was identified in 513 cases (70.8%); this was viral in 299 (41.2%), bacterial in 175 (24.1%) and fungal in 35 (4.8%). Cryptococcal meningitis (24 cases) was diagnosed as frequently as pneumococcal meningitis (24 cases). There were only 2 CNS infections with a<jats:italic>S<\/jats:italic>.<jats:italic>pneumoniae<\/jats:italic>serotype in the 13-valent pneumococcal vaccine after its addition to the National Immunisation schedule in 2011. Tropical pathogens\u2013including<jats:italic>Cryptococcus species<\/jats:italic>(9\/84, 11%),<jats:italic>Mycobacterium tuberculosis<\/jats:italic>(7\/84, 8%) and<jats:italic>Burkholderia pseudomallei<\/jats:italic>(5\/84, 6%)\u2013were among the most common causes of brain abscess. However, arboviral CNS infections were rare, with only one locally acquired case\u2014a dengue infection in 2009\u2014diagnosed in the entire study period. Intensive Care Unit admission was necessary in 14.3%; the overall case fatality rate was 4.4%.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusion<\/jats:title><jats:p>Tropical pathogens cause CNS infections as commonly as traditional bacterial pathogens in this region of tropical Australia. However, despite being highlighted in the national consensus guidelines, arboviruses were identified very rarely. Prompt access to sophisticated diagnostic and supportive care in Australia\u2019s well-resourced public health system is likely to have contributed to the cohort\u2019s low case-fatality rate.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0265410","type":"journal-article","created":{"date-parts":[[2022,3,21]],"date-time":"2022-03-21T17:33:45Z","timestamp":1647884025000},"page":"e0265410","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["The epidemiology and outcomes of central nervous system infections in Far North Queensland, tropical Australia; 2000-2019"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5556-1831","authenticated-orcid":true,"given":"Hannah","family":"Gora","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annie","family":"Preston-Thomas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Ramsamy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1423-3839","authenticated-orcid":true,"given":"Josh","family":"Hanson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,3,21]]},"reference":[{"issue":"9","key":"pone.0265410.ref001","first-page":"1595","article-title":"The burden and epidemiology of community-acquired central nervous system infections: a multinational study. 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