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Granerod J, Huang Y, Davies NWS, Sequeira PC, Mwapasa V, Rupali P, Michael BD, Solomon T, Easton A. Global Landscape of Encephalitis: Key Priorities to Reduce Future Disease Burden. Clin Infect Dis 2023; 77:1552-1560. [PMID: 37436770 PMCID: PMC10686956 DOI: 10.1093/cid/ciad417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 07/13/2023] Open
Abstract
Encephalitis affects people across the lifespan, has high rates of mortality and morbidity, and results in significant neurological sequelae with long-term consequences to quality of life and wider society. The true incidence is currently unknown due to inaccurate reporting systems. The disease burden of encephalitis is unequally distributed across the globe being highest in low- and middle-income countries where resources are limited. Here countries often lack diagnostic testing, with poor access to essential treatments and neurological services, and limited surveillance and vaccination programs. Many types of encephalitis are vaccine preventable, whereas others are treatable with early diagnosis and appropriate management. In this viewpoint, we provide a narrative review of key aspects of diagnosis, surveillance, treatment, and prevention of encephalitis and highlight priorities for public health, clinical management, and research, to reduce the disease burden.
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Affiliation(s)
- Julia Granerod
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, United Kingdom
- Dr JGW Consulting Ltd., London, United Kingdom
| | - Yun Huang
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, United Kingdom
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, United Kingdom
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | | | | | - Victor Mwapasa
- University of Malawi, College of Medicine, Blantyre, Malawi
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Benedict D Michael
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, United Kingdom
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, United Kingdom
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Tom Solomon
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, United Kingdom
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, United Kingdom
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- The Pandemic Institute, Liverpool, United Kingdom
| | - Ava Easton
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, United Kingdom
- The Encephalitis Society, Malton, United Kingdom
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Rohani H, Arjmand R, Mozhgani SH, Shafiee A, Javad Amini M, Forghani-Ramandi MM. The Worldwide Prevalence of Herpes Simplex Virus Encephalitis and Meningitis: A Systematic Review and Meta-Analysis. Turk Arch Pediatr 2023; 58:580-587. [PMID: 37553966 PMCID: PMC10724770 DOI: 10.5152/turkarchpediatr.2023.23007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/21/2023] [Indexed: 08/10/2023]
Abstract
Given the relatively high frequency of central nervous system infections and considerable mor- tality and morbidity reported to be caused by herpes simplex viruses among the other viral agents, having a clear knowledge about their epidemiological profile seems necessary. This systematic review and meta-analysis aimed to determine the relative frequency and preva- lence of herpes simplex encephalitis and meningitis in patients tested for viral etiologies. A comprehensive systematic review was performed in PubMed, Scopus, and Web of Science databases, searching for studies on the prevalence and relative frequency of herpes sim- plex virus 1 and herpes simplex virus 2 encephalitis and meningitis. Seventy-one studies were included. Overall, the prevalence of herpes simplex virus encephalitis among patients tested was 8% (95% confidence interval, 6%-11%; I2 = 98%) and the prevalence of herpes simplex virus meningitis among aseptic patients tested was 4% (95% confidence interval, 3%-7%; I2 = 95%), and a significant difference was observed by region. The results of our subgroup analysis for herpes simplex virus encephalitis revealed a prevalence of 8% for pediatric patients and ado- lescents and 12% for adults. The results for herpes simplex virus meningitis showed a prevalence of 4% for pediatric patients and adolescents and 9% for adults. We observed significant differ- ences in the frequency of herpes simplex virus 1 and herpes simplex virus 2 detection rates by region. Having high rates of missed cases due to inadequate, highly sensitive paraclinical tests performed on patients with suspected viral central nervous system infection is one of the pos- sible factors. More studies are needed to detect the possible flaws in the process of diagnosis in different regions.
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Affiliation(s)
- Hoorieh Rohani
- Student Research Committee, Alborz University of Medical Sciences Faculty of Medicine, Karaj, Iran
| | - Reza Arjmand
- Department of Pediatrics, Imam Ali Hospital, Alborz University of Medical Sciences, Alborz, Karaj, Iran
| | - Sayed-Hamidreza Mozhgani
- Department of Microbiology, Alborz University of Medical Sciences Faculty of Medicine, Karaj, Iran
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Arman Shafiee
- Student Research Committee, Alborz University of Medical Sciences Faculty of Medicine, Karaj, Iran
| | - Mohammad Javad Amini
- Student Research Committee, Alborz University of Medical Sciences Faculty of Medicine, Karaj, Iran
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Brindle HE, Bastos LS, Christley R, Contamin L, Dang LH, Anh DD, French N, Griffiths M, Nadjm B, van Doorn HR, Thai PQ, Duong TN, Choisy M. The spatio-temporal distribution of acute encephalitis syndrome and its association with climate and landcover in Vietnam. BMC Infect Dis 2023; 23:403. [PMID: 37312047 DOI: 10.1186/s12879-023-08300-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/03/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Acute encephalitis syndrome (AES) differs in its spatio-temporal distribution in Vietnam with the highest incidence seen during the summer months in the northern provinces. AES has multiple aetiologies, and the cause remains unknown in many cases. While vector-borne disease such as Japanese encephalitis and dengue virus and non-vector-borne diseases such as influenza and enterovirus show evidence of seasonality, associations with climate variables and the spatio-temporal distribution in Vietnam differs between these. The aim of this study was therefore to understand the spatio-temporal distribution of, and risk factors for AES in Vietnam to help hypothesise the aetiology. METHODS The number of monthly cases per province for AES, meningitis and diseases including dengue fever; influenza-like-illness (ILI); hand, foot, and mouth disease (HFMD); and Streptococcus suis were obtained from the General Department for Preventive Medicine (GDPM) from 1998-2016. Covariates including climate, normalized difference vegetation index (NDVI), elevation, the number of pigs, socio-demographics, JEV vaccination coverage and the number of hospitals were also collected. Spatio-temporal multivariable mixed-effects negative binomial Bayesian models with an outcome of the number of cases of AES, a combination of the covariates and harmonic terms to determine the magnitude of seasonality were developed. RESULTS The national monthly incidence of AES declined by 63.3% over the study period. However, incidence increased in some provinces, particularly in the Northwest region. In northern Vietnam, the incidence peaked in the summer months in contrast to the southern provinces where incidence remained relatively constant throughout the year. The incidence of meningitis, ILI and S. suis infection; temperature, relative humidity with no lag, NDVI at a lag of one month, and the number of pigs per 100,000 population were positively associated with the number of cases of AES in all models in which these covariates were included. CONCLUSIONS The positive correlation of AES with temperature and humidity suggest that a number of cases may be due to vector-borne diseases, suggesting a need to focus on vaccination campaigns. However, further surveillance and research are recommended to investigate other possible aetiologies such as S. suis or Orientia tsutsugamushi.
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Affiliation(s)
- Hannah E Brindle
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
- Oxford University Clinical Research Unit, Hanoi City, Vietnam.
| | - Leonardo S Bastos
- Scientific Computing Programme, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Robert Christley
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Lucie Contamin
- Institut de Recherche Pour Le Développement, Hanoi, Vietnam
| | - Le Hai Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Dang Duc Anh
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Neil French
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Michael Griffiths
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Behzad Nadjm
- Oxford University Clinical Research Unit, Hanoi City, Vietnam
- MRC Unit The Gambia at the London, School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Pham Quang Thai
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
- School Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Tran Nhu Duong
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Marc Choisy
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
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Dieu NTT, Phuong ND, Le Thao MN, Chambers M, Nguyen DM, Nguyen HTL, Vu HTT, Pham TN, van Doorn R, Van Nuil JI. Knowledge and attitudes toward complete diagnostic autopsy and minimally invasive autopsy: A cross-sectional survey in Hanoi, Vietnam. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001685. [PMID: 36963097 PMCID: PMC10022770 DOI: 10.1371/journal.pgph.0001685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/14/2023] [Indexed: 03/19/2023]
Abstract
Knowing the cause of death (CoD) plays an important role in developing strategies and interventions to prevent early mortality. In Vietnam, the CoD of the majority of patients who acquired infectious diseases remains unknown. While there are challenges that hinder the use of complete diagnostic autopsy (CDA) in practice, minimally invasive autopsy (MIA) might be a promising alternative to establish CoD in Vietnam. The current study aims to explore knowledge of and attitudes toward CDA and MIA in the wider population in Vietnam. The study was cross-sectional, using structured questionnaires that were disseminated electronically via several websites and as paper-based forms in a national level hospital in Vietnam. Descriptive analyses were performed and where appropriate, comparisons between the healthcare workers and the general public were performed. We included 394 questionnaires in the analysis. The majority of participants were under age 40, living in major cities and currently practicing no religion. 76.6% of respondents were aware of CDA and among them, 98% acknowledged its importance in medicine. However, most participants thought that CDA should only be performed when the CoD was suspicious or unconfirmed because of its the invasive nature. For MIA, only 22% were aware of the method and there was no difference in knowledge of MIA between healthcare workers and the wider public. The questionnaire results showed that there are socio-cultural barriers that hinder the implementation of CDA in practice. While the awareness of MIA among participants was low, the minimally invasive nature of the method is promising for implementation in Vietnam. A qualitative study is needed to further explore the ethical, socio-cultural and/or religious barriers that might hinder the implementation of MIA in Vietnam.
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Affiliation(s)
- Ngan Ta Thi Dieu
- National Hospital for Tropical Diseases, Ha Noi, Vietnam
- Department of Infectious Diseases–Hanoi Medical University, Ha Noi, Vietnam
| | | | | | - Mary Chambers
- Oxford University Clinical Research Unit, HCMC, Vietnam
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Ha Thi Lien Nguyen
- National Hospital for Tropical Diseases, Ha Noi, Vietnam
- Department of Infectious Diseases–Hanoi Medical University, Ha Noi, Vietnam
| | | | | | - Rogier van Doorn
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, Ha Noi, Vietnam
| | - Jennifer Ilo Van Nuil
- Oxford University Clinical Research Unit, HCMC, Vietnam
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Brindle HE, Nadjm B, Choisy M, Christley R, Griffiths M, Baker S, Bryant JE, Campbell JI, Nguyen VVC, Nguyen TND, Vu TTH, Nguyen VH, Hoang BL, Le XL, Pham HM, Ta TDN, Ho DTN, Tran TN, Nguyen THN, Tran MP, Pham THP, Le VT, Nguyen DT, Hau TTT, Nguyen NV, Wertheim HFL, Thwaites GE, van Doorn HR. Aetiology and Potential Animal Exposure in Central Nervous System Infections in Vietnam. ECOHEALTH 2022; 19:463-474. [PMID: 36227390 PMCID: PMC9558024 DOI: 10.1007/s10393-022-01611-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 05/20/2022] [Indexed: 06/16/2023]
Abstract
An estimated 73% of emerging infections are zoonotic in origin, with animal contact and encroachment on their habitats increasing the risk of spill-over events. In Vietnam, close exposure to a wide range of animals and animal products can lead to acquisition of zoonotic pathogens, a number of which cause central nervous system (CNS) infections. However, studies show the aetiology of CNS infections remains unknown in around half of cases. We used samples and data from hospitalised patients with CNS infections, enrolled into the Vietnam Initiative on Zoonotic Infections multicentre study, to determine the association between aetiology and animal contact including those in whom the cause was unknown. Among 933 patients, a pathogen or an antibody response to it was identified in 291 (31.2%, 95% CI 28.3-34.3%). The most common pathogens were Streptococcus suis (n = 91 (9.8%, 8.0-11.9%)) and Japanese encephalitis virus (JEV) (n = 72 (7.7%, 6.1-9.7%)). Commonly reported animal contact included keeping, raising or handling (n = 364 (39.0%, 35.9-42.2%)) and handling, cooking or consuming raw meat, blood or viscera in the 2 weeks prior to symptom onset (n = 371 (39.8%, 36.6-43.0%)), with the latter most commonly from pigs (n = 343 (36.9%, 33.8-40.1%). There was no association between an unknown aetiology and exposure to animals in a multivariate logistic regression. Further testing for unknown or undetected pathogens may increase diagnostic yield, however, given the high proportion of zoonotic pathogens and the presence of risk factors, increasing public awareness about zoonoses and preventive measures can be considered.
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Affiliation(s)
- Hannah E Brindle
- Oxford University Clinical Research Unit, Hanoi, Vietnam.
- Institute of Infection and Global Health and National Institute, University of Liverpool, Liverpool, UK.
| | - Behzad Nadjm
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Serekunda, The Gambia
| | - Marc Choisy
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Rob Christley
- Institute of Infection and Global Health and National Institute, University of Liverpool, Liverpool, UK
| | - Michael Griffiths
- Institute of Infection and Global Health and National Institute, University of Liverpool, Liverpool, UK
| | - Stephen Baker
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Juliet E Bryant
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - James I Campbell
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Ty Thi Hang Vu
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Bao Long Hoang
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Hanoi Medical University, Hanoi, Vietnam
| | - Xuan Luat Le
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Ha My Pham
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Wellcome Trust Sanger Institute, Hinxton, UK
| | | | | | | | | | - My Phuc Tran
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Van Tan Le
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Thi Thu Trang Hau
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Research Group 2, AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Heiman F L Wertheim
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- RadboudUMC, Nijmegen, The Netherlands
| | - Guy E Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Phi DL, Tran XD, To MM, Dang HY, Pham TD, Vu TTT, Tran TK, Do MD, Vu TT, Ranque S, Ninove L, Pillet S, Colson P, La Scola B, Hoang VT, Gautret P. Outbreak of central nervous system infections among children in Thai Binh, Viet Nam. Emerg Microbes Infect 2022; 11:1683-1692. [PMID: 35699079 PMCID: PMC9225704 DOI: 10.1080/22221751.2022.2088405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
From July to October 2020, 99 cases of central nervous system (CNS) infections were identified in Thai Binh Pediatric Hospital, Viet Nam, representing a five-fold increase compared to the baseline incidence during the previous five years. Clinical data were retrospectively collected. Cerebrospinal fluid specimens (CSF) were secondarily tested for pathogens using viral culture and PCR assays. Patient median age was 5 years (0–12 years); 58.6% were male. Of these children, 83.8% had CSF white blood culture (WBC) counts of ≥ 10 cells/µL, including 58 of 99 (58.6%) with a WBC count ≥ 100 cells/µL. Overall, 72 (72.7%) patients had confirmed infections with a pathogen identified in the CSF, the majority of which (66) were enterovirus. Sequencing results suggested that the rise of incidence observed in 2020 was due to Echovirus 4 (n = 45), Echovirus 30 (n = 8), and Echovirus 6 (n = 1) circulation. A confirmed CNS infection was significantly associated with older age (≥5 years, OR = 3.64, p = 0.03) and with an increased WBC count in the CSF (OR = 6.38, p-value = 0.01 for WBCs from 10 to <100 and OR = 7.90, p-value = 0.002 for WBCs ≥100). Ninety-seven (97) of 99 (98.0%) children received empiric antimicrobial treatment, and 35 (35.3%) were treated with multiple antibiotics. Eighty-four (84) patients (84.9%) were discharged home, and 11 (11.1%) were transferred to the National Hospital because their condition had worsened. No deaths were recorded. Point-of-care tests, including real-time PCR assays to identify common pathogens, should be implemented for more accurate diagnosis and more appropriate antibiotic use.
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Affiliation(s)
- Duc Long Phi
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Xuan Duong Tran
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam.,IHU-Méditerranée Infection, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Minh Manh To
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Hai Yen Dang
- Thai Binh Pediatric Hospital, Thai Binh, Viet Nam
| | - Thi Dung Pham
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Thi Thu Trang Vu
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | | | - Manh Dung Do
- Thai Binh Pediatric Hospital, Thai Binh, Viet Nam
| | - Thi Thuy Vu
- Thai Binh Pediatric Hospital, Thai Binh, Viet Nam
| | - Stéphane Ranque
- IHU-Méditerranée Infection, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Laetitia Ninove
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,Unité des Virus Émergents (UVE: Aix-Marseille Univ - IRD 190 - Inserm 1207 - IHU Méditerranée Infection), Marseille, France
| | - Sylvie Pillet
- Laboratoire des agents infectieux et d'hygiène, CHU de Saint-Étienne, France.,CIRI- International Center of Research in Infectiology, Centre International de Recherche en Infectiologie, GIMAP Team University of Lyon, University of St-Etienne, INSERM U1111, CNRS UMR5308, ENS Lyon, Claude Bernard Lyon 1 University, Lyon, France
| | - Philippe Colson
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Bernard La Scola
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Van Thuan Hoang
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam.,IHU-Méditerranée Infection, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Philippe Gautret
- IHU-Méditerranée Infection, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
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Khalili M, Rahimi Hajiabadi H, Akbari M, Nasr Esfahani B, Saleh R, Moghim S. Viral aetiology of acute central nervous system infections in children, Iran. J Med Microbiol 2022; 71. [DOI: 10.1099/jmm.0.001602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Viral infections are increasingly an important cause of central nervous system (CNS) complications.
Hypothesis/Gap Statement. There is no comprehensive insight about CNS infections due to viral agents among Iranian children.
Aim. This study aimed to investigate the viral aetiology, clinical and epidemiological profile of children with acute infections of the CNS.
Methodology. A prospective study was conducted on children at the referral hospital in Isfahan, Iran, from June 2019 to June 2020. A multiplex PCR assay was used to detect the viral causative agent in cerebrospinal fluid and throat/rectal swab samples.
Results. Among 103 patients with eligible criteria, a confirmed or probable viral aetiology was detected in 41 (39.8 %) patients, including enteroviruses – 56.1 %, herpes simplex virus 1/2 (HSV-1/2) – 31.7 %, Epstein-Barr virus – 17.1 %, varicella-zoster virus (VZV) – 9.7 %, influenza A virus (H1N1) –4.9 % and mumps – 2.4 %. There was a higher proportion of PCR-positive samples in infants than in other age groups. Encephalitis and meningoencephalitis were diagnosed in 68.3 % (28/41) and 22 % (9/41) PCR-positive cases, respectively.
Conclusion. The findings of this research provide insights into the clinical and viral aetiological patterns of acute CNS infections in Iran, and the importance of molecular methods to identify CNS viruses. HSV and VZV were identified as important causes of encephalitis in young children.
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Affiliation(s)
- Maryam Khalili
- Department of Bacteriology and Virology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Rahimi Hajiabadi
- Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojtaba Akbari
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahram Nasr Esfahani
- Department of Bacteriology and Virology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rana Saleh
- Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sharareh Moghim
- Department of Bacteriology and Virology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Wang J, Ye J, Yang L, Chen X, Fang H, Liu Z, Xia G, Zhang Y, Zhang Z. Inconsistency analysis between metagenomic next-generation sequencing results of cerebrospinal fluid and clinical diagnosis with suspected central nervous system infection. BMC Infect Dis 2022; 22:764. [PMID: 36180859 PMCID: PMC9523998 DOI: 10.1186/s12879-022-07729-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background Recently, with the rapid progress of metagenomic next-generation sequencing (mNGS), inconsistency between mNGS results and clinical diagnoses has become more common. There is currently no reasonable explanation for this, and the interpretation of mNGS reports still needs to be standardised. Methods A retrospective analysis was conducted on 47 inpatients with suspected central nervous system (CNS) infections, and clinical data were recorded. The final diagnosis was determined by an expert group based on the patient’s clinical manifestation, laboratory examination, and response to treatment. mNGS results were compared with the final diagnosis, and any inconsistencies that occurred were investigated. Finally, the credibility of mNGS results was evaluated using the integral approach, which consists of three parts: typical clinical features, positive results with the traditional method, and cerebrospinal fluid cells ≥ 100 (× 106/L) or protein ≥ 500 mg/L, with one point for each item. Results Forty-one patients with suspected CNS infection were assigned to infected (ID, 31/41, 75.61%) and non-infected groups (NID, 10/41, 24.39%) after assessment by a panel of experts according to the composite diagnostic criteria. For mNGS-positive results, 20 of the 24 pathogens were regarded as contaminants when the final score was ≤ 1. The remaining 11 pathogens detected by mNGS were all true positives, which was consistent with the clinical diagnosis when the score was ≥ 2. For mNGS negative results, when the score was ≥ 2, the likelihood of infection may be greater than when the score is ≤ 1. Conclusion The integral method is effective for evaluating mNGS results. Regardless of whether the mNGS result was positive or negative, the possibility of infection was greater when the score was ≥ 2. A negative mNGS result does not necessarily indicate that the patient was not clinically infected, and, therefore, clinical features are more important. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07729-0.
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Affiliation(s)
- Jin Wang
- Department of Infectious Diseases, The Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Jun Ye
- Department of Infectious Diseases, The Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Liqi Yang
- Department of Infection Management, The Second Hospital of Anhui Medical University, Hefei, China
| | - Xiangfeng Chen
- Department of Infection Management, The Second Hospital of Anhui Medical University, Hefei, China
| | - Haoshu Fang
- Department of Pathophysiology, Anhui Medical University, Hefei, China
| | - Zhou Liu
- Department of Clinical Laboratory, The Second Hospital of Anhui Medical University, Hefei, China
| | - Guomei Xia
- Department of Infectious Diseases, The Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Yafei Zhang
- Department of Infectious Diseases, The Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Zhenhua Zhang
- Department of Infectious Diseases, The Second Hospital of Anhui Medical University, Hefei, 230601, China.
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Huong NHT, Toan ND, Quy DT, Khanh TH, Thinh LQ, Nhan LNT, Minh NNQ, Turner H, Thwaites L, Irani S, Hung NT, Tan LV. Study protocol: The clinical features, epidemiology, and causes of paediatric encephalitis in southern Vietnam. Wellcome Open Res 2022; 6:133. [PMID: 36300174 PMCID: PMC9579742 DOI: 10.12688/wellcomeopenres.16770.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 01/13/2023] Open
Abstract
Encephalitis is a major cause of morbidity and mortality worldwide. The clinical syndrome of encephalitis consists of altered mental status, seizures, neurologic signs, and is often accompanied by fever, headache, nausea, and vomiting. The encephalitis in children has been known that more common than in adult, with the incidence rate of infants was 3.9 times higher than that of people 20-44 years of age. The reported incidence of hospitalization attributed to paediatric encephalitis ranged from 3 to 13 admissions per 100,000 children per year with the overall mortality ranging from 0 to 7%. There are however more than 100 pathogens that can cause encephalitis and accurate diagnosis is challenging. Over 50% of patients with encephalitis are left undiagnosed despite extensive laboratory investigations. Furthermore, recent studies in high-income settings have suggested autoimmune encephalitis has now surpassed infectious aetiologies, mainly due to increased awareness and diagnostic capacity, which further challenges routine diagnosis and clinical management, especially in developing countries. There are limited contemporary data on the causes of encephalitis in children in Vietnam. Improving our knowledge of the causative agents of encephalitis in this resource-constrained setting remains critical to informing case management, resource distribution and vaccination strategy. Therefore, we conduct a prospective observational study to characterise the clinical, microbiological, and epidemiological features of encephalitis in a major children's hospital in southern Vietnam. Admission clinical samples will be collected alongside meta clinical data and from each study participants. A combination of classical assays (serology and PCR) and metagenomic next-generation sequencing will used to identify the causative agents. Undiagnosed patients with clinical presentations compatible with autoimmune encephalitis will then be tested for common forms of the disease. Finally, using direct- and indirect costs, we will estimate the economic burden of hospitalization and seven days post hospital discharge of paediatric encephalitis in our setting.
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Affiliation(s)
- Nguyen Hoang Thien Huong
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam,Children's Hospital 1, Ho Chi Minh City, 700000, Vietnam,
| | | | - Du Tuan Quy
- Children's Hospital 1, Ho Chi Minh City, 700000, Vietnam
| | | | - Le Quoc Thinh
- Children's Hospital 1, Ho Chi Minh City, 700000, Vietnam
| | | | | | - Hugo Turner
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam
| | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam
| | - Sarosh Irani
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam,
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10
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Huong NHT, Toan ND, Quy DT, Khanh TH, Thinh LQ, Nhan LNT, Minh NNQ, Turner H, Thwaites L, Irani S, Hung NT, Tan LV. Study protocol: The clinical features, epidemiology, and causes of paediatric encephalitis in southern Vietnam. Wellcome Open Res 2022; 6:133. [PMID: 36300174 PMCID: PMC9579742 DOI: 10.12688/wellcomeopenres.16770.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 01/13/2023] Open
Abstract
Encephalitis is a major cause of morbidity and mortality worldwide. The clinical syndrome of encephalitis consists of altered mental status, seizures, neurologic signs, and is often accompanied by fever, headache, nausea, and vomiting. The encephalitis in children has been known that more common than in adult, with the incidence rate of infants was 3.9 times higher than that of people 20-44 years of age. The reported incidence of hospitalization attributed to paediatric encephalitis ranged from 3 to 13 admissions per 100,000 children per year with the overall mortality ranging from 0 to 7%. There are however more than 100 pathogens that can cause encephalitis and accurate diagnosis is challenging. Over 50% of patients with encephalitis are left undiagnosed despite extensive laboratory investigations. Furthermore, recent studies in high-income settings have suggested autoimmune encephalitis has now surpassed infectious aetiologies, mainly due to increased awareness and diagnostic capacity, which further challenges routine diagnosis and clinical management, especially in developing countries. There are limited contemporary data on the causes of encephalitis in children in Vietnam. Improving our knowledge of the causative agents of encephalitis in this resource-constrained setting remains critical to informing case management, resource distribution and vaccination strategy. Therefore, we conduct a prospective observational study to characterise the clinical, microbiological, and epidemiological features of encephalitis in a major children's hospital in southern Vietnam. Admission clinical samples will be collected alongside meta clinical data and from each study participants. A combination of classical assays (serology and PCR) and metagenomic next-generation sequencing will used to identify the causative agents. Undiagnosed patients with clinical presentations compatible with autoimmune encephalitis will then be tested for common forms of the disease. Finally, using direct- and indirect costs, we will estimate the economic burden of hospitalization and seven days post hospital discharge of paediatric encephalitis in our setting.
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Affiliation(s)
- Nguyen Hoang Thien Huong
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam,Children's Hospital 1, Ho Chi Minh City, 700000, Vietnam,
| | | | - Du Tuan Quy
- Children's Hospital 1, Ho Chi Minh City, 700000, Vietnam
| | | | - Le Quoc Thinh
- Children's Hospital 1, Ho Chi Minh City, 700000, Vietnam
| | | | | | - Hugo Turner
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam
| | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam
| | - Sarosh Irani
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam,
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11
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Huong NHT, Toan ND, Quy DT, Khanh TH, Thinh LQ, Nhan LNT, Minh NNQ, Turner H, Thwaites L, Irani S, Hung NT, Tan LV. Study protocol: The clinical features, epidemiology, and causes of paediatric encephalitis in southern Vietnam. Wellcome Open Res 2022; 6:133. [PMID: 36300174 PMCID: PMC9579742 DOI: 10.12688/wellcomeopenres.16770.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 01/13/2023] Open
Abstract
Encephalitis is a major cause of morbidity and mortality worldwide. The clinical syndrome of encephalitis consists of altered mental status, seizures, neurologic signs, and is often accompanied by fever, headache, nausea, and vomiting. The encephalitis in children has been known that more common than in adult, with the incidence rate of infants was 3.9 times higher than that of people 20-44 years of age. The reported incidence of hospitalization attributed to paediatric encephalitis ranged from 3 to 13 admissions per 100,000 children per year with the overall mortality ranging from 0 to 7%. There are however more than 100 pathogens that can cause encephalitis and accurate diagnosis is challenging. Over 50% of patients with encephalitis are left undiagnosed despite extensive laboratory investigations. Furthermore, recent studies in high-income settings have suggested autoimmune encephalitis has now surpassed infectious aetiologies, mainly due to increased awareness and diagnostic capacity, which further challenges routine diagnosis and clinical management, especially in developing countries. There are limited contemporary data on the causes of encephalitis in children in Vietnam. Improving our knowledge of the causative agents of encephalitis in this resource-constrained setting remains critical to informing case management, resource distribution and vaccination strategy. Therefore, we conduct a prospective observational study to characterise the clinical, microbiological, and epidemiological features of encephalitis in a major children's hospital in southern Vietnam. Admission clinical samples will be collected alongside meta clinical data and from each study participants. A combination of classical assays (serology and PCR) and metagenomic next-generation sequencing will used to identify the causative agents. Undiagnosed patients with clinical presentations compatible with autoimmune encephalitis will then be tested for common forms of the disease. Finally, using direct- and indirect costs, we will estimate the economic burden of hospitalization and seven days post hospital discharge of paediatric encephalitis in our setting.
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Affiliation(s)
- Nguyen Hoang Thien Huong
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam,Children's Hospital 1, Ho Chi Minh City, 700000, Vietnam,
| | | | - Du Tuan Quy
- Children's Hospital 1, Ho Chi Minh City, 700000, Vietnam
| | | | - Le Quoc Thinh
- Children's Hospital 1, Ho Chi Minh City, 700000, Vietnam
| | | | | | - Hugo Turner
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam
| | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam
| | - Sarosh Irani
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam,
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12
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Zaman K, Yunus M, Aziz AB, Feser J, Mooney J, Tang Y, Ellison DW, Thaisomboonsuk B, Zhang L, Neuzil KM, Marfin AA, Letson GW. Antibody persistence and immune memory response following primary vaccination and boosting with live attenuated SA 14-14-2 Japanese encephalitis vaccine (CD-JEV) in Bangladesh: A phase 4 open-label clinical trial. Vaccine X 2022; 10:100143. [PMID: 35243320 PMCID: PMC8857502 DOI: 10.1016/j.jvacx.2022.100143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/22/2021] [Accepted: 01/25/2022] [Indexed: 11/30/2022] Open
Abstract
Despite a lack of measurable antibody four years after primary vaccination, the anamnestic response to a booster dose of live, attenuated SA 14-14-2 Japanese encephalitis vaccine indicates immunity persists. Live, attenuated SA 14-14-2 Japanese encephalitis vaccine is safe and well-tolerated.
Introduction Japanese encephalitis (JE) virus is one of the leading causes of viral encephalitis across temperate and tropical zones of Asia. The live attenuated SA 14-14-2 JE vaccine (CD-JEV) is one of three vaccines prequalified by the World Health Organization (WHO) to prevent JE. WHO currently recommends a single CD-JEV dose for infants in endemic settings. However, in the absence of long-term immunogenicity data, WHO has indicated a need for long-term immunogenicity studies to inform optimal dosing schedules and determine the need for booster doses. Methods This Phase 4, open-label clinical study measured neutralizing antibody (NAb) titers in Bangladeshi children three and four years after primary CD-JEV vaccination and 7 and 28 days after a booster CD-JEV vaccination given four years after primary vaccination. The study also assessed the tolerability and safety of the booster dose. A NAb titer of ≥1:10 was considered seroprotective. Results Of 560 children vaccinated between 10 and 12 months of age with CD-JEV three years earlier and enrolled in this study from 30 July 2015 through 03 January 2016, 52 (9.3%; 95% CI: 7.2–12.0) had a seroprotective titer at enrollment. One year later, of 533 children, 66 (12.4%; 95% CI: 9.9–15.5) had a seroprotective titer before receiving a booster dose. Of 524 children who received a booster CD-JEV dose, 479 (91.4%; 95% CI: 88.7–93.5) and 514 (98.1%; 95% CI: 96.5–99.0) were seroprotected 7 and 28 days later, respectively. The geometric mean titer (GMT) was 6 (95% CI: 6–6) at baseline, 105 (95% CI: 93–119) 7 days post-booster, and 167 (95% CI: 152–183) 28 days post-booster. No vaccine-associated neurologic adverse events or other serious adverse events were noted following the booster dose. Conclusions Although most children did not have measurable antibody titers three and four years after a single primary CD-JEV dose, more than 90% of seronegative children had a strong anamnestic response within one week of a booster dose. This suggests that these children were immune despite the absence of measurable NAb prior to their booster. ClinicalTrials.gov Identifier: NCT02514746.
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Affiliation(s)
- K Zaman
- International Centre for Diarrheal Disease Research, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Md Yunus
- International Centre for Diarrheal Disease Research, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Asma B Aziz
- International Centre for Diarrheal Disease Research, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Jodi Feser
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Suite 200, Seattle, Washington 98121, USA
| | - Jessica Mooney
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Suite 200, Seattle, Washington 98121, USA
| | - Yuxiao Tang
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Suite 200, Seattle, Washington 98121, USA
| | - Damon W Ellison
- Armed Forces Research Institute of Medicine Sciences, 315/6 Rajvithi Rd., Bangkok 10400, Thailand
| | - Butsaya Thaisomboonsuk
- Armed Forces Research Institute of Medicine Sciences, 315/6 Rajvithi Rd., Bangkok 10400, Thailand
| | - Lei Zhang
- Chengdu Institute of Biological Products Co., Ltd., 379, 3rd, Jinhua Road, Jinjiang District, Chengdu 61002, China
| | - Kathleen M Neuzil
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Suite 200, Seattle, Washington 98121, USA
| | - Anthony A Marfin
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Suite 200, Seattle, Washington 98121, USA
| | - G William Letson
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Suite 200, Seattle, Washington 98121, USA
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13
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Update on Viral Infections Involving the Central Nervous System in Pediatric Patients. CHILDREN-BASEL 2021; 8:children8090782. [PMID: 34572214 PMCID: PMC8470393 DOI: 10.3390/children8090782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 12/18/2022]
Abstract
Infections of the central nervous system (CNS) are mainly caused by viruses, and these infections can be life-threatening in pediatric patients. Although the prognosis of CNS infections is often favorable, mortality and long-term sequelae can occur. The aims of this narrative review were to describe the specific microbiological and clinical features of the most frequent pathogens and to provide an update on the diagnostic approaches and treatment strategies for viral CNS infections in children. A literature analysis showed that the most common pathogens worldwide are enteroviruses, arboviruses, parechoviruses, and herpesviruses, with variable prevalence rates in different countries. Lumbar puncture (LP) should be performed as soon as possible when CNS infection is suspected, and cerebrospinal fluid (CSF) samples should always be sent for polymerase chain reaction (PCR) analysis. Due to the lack of specific therapies, the management of viral CNS infections is mainly based on supportive care, and empiric treatment against herpes simplex virus (HSV) infection should be started as soon as possible. Some researchers have questioned the role of acyclovir as an empiric antiviral in older children due to the low incidence of HSV infection in this population and observed that HSV encephalitis may be clinically recognizable beyond neonatal age. However, the real benefit-risk ratio of selective approaches is unclear, and further studies are needed to define appropriate indications for empiric acyclovir. Research is needed to find specific therapies for emerging pathogens. Moreover, the appropriate timing of monitoring neurological development, performing neuroimaging evaluations and investigating the effectiveness of rehabilitation during follow-up should be evaluated with long-term studies.
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14
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Paliwal VK, Garg RK. Neurological Complications of Dengue: Beware of Striking Similarities with Severe COVID-19. Ann Indian Acad Neurol 2021; 24:645-647. [PMID: 35002119 PMCID: PMC8680904 DOI: 10.4103/aian.aian_470_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vimal K. Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh, India
| | - Ravindra K. Garg
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
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15
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Britton PN, Dale RC, Blyth CC, Clark JE, Crawford N, Marshall H, Elliott EJ, Macartney K, Booy R, Jones CA. Causes and Clinical Features of Childhood Encephalitis: A Multicenter, Prospective Cohort Study. Clin Infect Dis 2021; 70:2517-2526. [PMID: 31549170 DOI: 10.1093/cid/ciz685] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/24/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND We aimed to determine the contemporary causes, clinical features, and short-term outcome of encephalitis in Australian children. METHODS We prospectively identified children (≤14 years of age) admitted with suspected encephalitis at 5 major pediatric hospitals nationally between May 2013 and December 2016 using the Paediatric Active Enhanced Disease Surveillance (PAEDS) Network. A multidisciplinary expert panel reviewed cases and categorized them using published definitions. Confirmed encephalitis cases were categorized into etiologic subgroups. RESULTS From 526 cases of suspected encephalitis, 287 children met criteria for confirmed encephalitis: 57% (95% confidence interval [CI], 52%-63%) had infectious causes, 10% enterovirus, 10% parechovirus, 8% bacterial meningoencephalitis, 6% influenza, 6% herpes simplex virus (HSV), and 6% Mycoplasma pneumoniae; 25% (95% CI, 20%-30%) had immune-mediated encephalitis, 18% acute disseminated encephalomyelitis, and 6% anti-N-methyl-d-aspartate receptor encephalitis; and 17% (95% CI, 13%-21%) had an unknown cause. Infectious encephalitis occurred in younger children (median age, 1.7 years [interquartile range {IQR}, 0.1-6.9]) compared with immune-mediated encephalitis (median age, 7.6 years [IQR, 4.6-12.4]). Varicella zoster virus encephalitis was infrequent following high vaccination coverage since 2007. Thirteen children (5%) died: 11 with infectious causes (2 influenza; 2 human herpesvirus 6; 2 group B Streptococcus; 2 Streptococcus pneumoniae; 1 HSV; 1 parechovirus; 1 enterovirus) and 2 with no cause identified. Twenty-seven percent (95% CI, 21%-31%) of children showed moderate to severe neurological sequelae at discharge. CONCLUSIONS Epidemic viral infections predominated as causes of childhood encephalitis in Australia. The leading causes include vaccine-preventable diseases. There were significant differences in age, clinical features, and outcome among leading causes. Mortality or short-term neurological morbidity occurred in one-third of cases.
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Affiliation(s)
- Philip N Britton
- Discipline of Child and Adolescent Health, Sydney Medical School, Children's Hospital at Westmead, New South Wales.,Marie Bashir Institute of Infectious Diseases and Biosecurity Institute, University of Sydney, New South Wales.,Departments of Infectious Diseases and Microbiology, New South Wales
| | - Russell C Dale
- Discipline of Child and Adolescent Health, Sydney Medical School, Children's Hospital at Westmead, New South Wales.,Neurology, Children's Hospital at Westmead, New South Wales
| | - Christopher C Blyth
- Perth Children's Hospital, Nedlands, Perth, Western Australia.,Telethon Kids Institute and School of Medicine, University of Western Australia, Nedlands, Perth, Western Australia.,PathWest Laboratory Medicine Western Australia and Queen Elizabeth II Medical Centre, Nedlands, Perth, Western Australia
| | - Julia E Clark
- Children's Health Queensland, Brisbane.,School of Clinical Medicine, University of Queensland, Brisbane
| | - Nigel Crawford
- Murdoch Children's Research Institute and Royal Children's Hospital, Victoria.,University of Melbourne, Victoria
| | - Helen Marshall
- Women's and Children's Hospital, South Australia.,Robinson Research Institute, University of Adelaide, South Australia, and
| | - Elizabeth J Elliott
- Discipline of Child and Adolescent Health, Sydney Medical School, Children's Hospital at Westmead, New South Wales.,Australian Paediatric Surveillance Unit, New South Wales, Australia
| | - Kristine Macartney
- Discipline of Child and Adolescent Health, Sydney Medical School, Children's Hospital at Westmead, New South Wales.,Departments of Infectious Diseases and Microbiology, New South Wales.,National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - Robert Booy
- Discipline of Child and Adolescent Health, Sydney Medical School, Children's Hospital at Westmead, New South Wales.,Marie Bashir Institute of Infectious Diseases and Biosecurity Institute, University of Sydney, New South Wales.,Departments of Infectious Diseases and Microbiology, New South Wales.,National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - Cheryl A Jones
- Marie Bashir Institute of Infectious Diseases and Biosecurity Institute, University of Sydney, New South Wales.,Murdoch Children's Research Institute and Royal Children's Hospital, Victoria.,University of Melbourne, Victoria
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16
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You D, Chen F, Li J, Zeng X, Wang W, Guo Y, Yang F, Sun S, Wang L. Prospective case-control study of enterovirus detection differences in children's cerebrospinal fluid between multiplex PCR and real-time RT-PCR assay. J Clin Lab Anal 2020; 35:e23606. [PMID: 33146929 PMCID: PMC7891498 DOI: 10.1002/jcla.23606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/25/2020] [Accepted: 09/15/2020] [Indexed: 12/13/2022] Open
Abstract
Background Viral encephalitis is common in childhood. It is an acute brain parenchymal inflammation caused by a variety of viral infection, and enterovirus accounts for the majority. Due to atypical clinical manifestations, pathogenic testing is important for assisting clinical diagnosis. The purpose of this study was to evaluate the performance of the multiplex PCR assay compared with quantitative real‐time PCR for enterovirus detection. Methods A prospective case‐control study was performed involving 103 pediatric patients suspected for viral encephalitis and cerebrospinal fluid (CSF) samples were collected and tested for 9 pathogens using multiplex PCR assay during April to November in 2018. In parallel, an aliquot of samples was tested for enterovirus infection by real‐time PCR assay. Results There were 85.4% children were confirmed as viral encephalitis on discharge, the remaining ones were diagnosed as other CNS diseases, such as epilepsy. The specificity of the two methods was the same as that of the clinical diagnosis, but the sensitivity and consistency with clinical diagnosis of multiplex PCR were both higher than the real‐time PCR. Besides of enterovirus, multiplex PCR could also detect coinfection of enterovirus with Epstein‐Barr virus and mumps virus. Conclusion Results of multiplex PCR method are more consistent with the clinical diagnosis and are superior to real‐time PCR for detecting enterovirus in CSF.
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Affiliation(s)
- Dianping You
- Institute of Pediatric Research, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Fang Chen
- Department of Neurology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Jingjie Li
- Department of Neurology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | | | | | - Yinghui Guo
- Institute of Pediatric Research, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Fan Yang
- Institute of Pediatric Research, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Suzhen Sun
- Department of Neurology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Le Wang
- Institute of Pediatric Research, Children's Hospital of Hebei Province, Shijiazhuang, China
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17
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Abstract
BACKGROUND Viral meningoencephalitis is highly heterogeneous, varying by geographic location. The aim of this study was to characterize the etiology and reporting the clinical findings and outcome of viral encephalitis in children in southern Brazil. METHODS A cross-Sectional study was conducted at Hospital Pequeno Príncipe, Curitiba, Brazil, between January 2013 and December 2017. It included patients younger than 18 years, who fulfilled the criteria: altered mental status as a major criteria and 2 or more minor criteria (1) fever, (2) seizures, (3) focal neurologic findings, (4) central system fluid white cell count of ≥5 cells/mm, (5) abnormal brain imaging, and/or (6) electroencephalogram abnormalities. RESULTS Viral meningoencephalitis was diagnosed in 270 children, with median age of 2 years (interquartile range: 0-4), The etiology of viral meningoencephalitis was confirmed in 47% of patients. Enterovirus (18%) was the major cause of encephalitis in Southern Brazilian children, and a high prevalence of Epstein-Barr virus (6%) was demonstrated. Most patients presented with fever (81%), followed by vomiting (50%), focal neurologic findings (46%), seizures (31%) and headache (30%). Few abnormalities were detected on electroencephalograms and brain magnetic resonance images. On discharge from hospital, symptoms resolved completely in 87% of children. Sequelae were mainly observed in patients with focal neurologic symptoms (P<0.001), presence of seizures (P<0.001) and electroencephalogram abnormalities (P=0.024). CONCLUSIONS Enterovirus was the major cause of encephalitis. Etiologic agent of encephalitis seems to be influenced by the local virologic pattern. A poor outcome was identified in patients with seizures, focal neurologic findings and electroencephalogram abnormalities.
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18
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Malekmohammad K, Rafieian-Kopaei M, Sardari S, Sewell RDE. Effective Antiviral Medicinal Plants and Biological Compounds Against Central Nervous System Infections: A Mechanistic Review. Curr Drug Discov Technol 2020; 17:469-483. [PMID: 31309894 DOI: 10.2174/1570163816666190715114741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/26/2019] [Accepted: 04/30/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Infectious diseases are amongst the leading causes of death in the world and central nervous system infections produced by viruses may either be fatal or generate a wide range of symptoms that affect global human health. Most antiviral plants contain active phytoconstituents such as alkaloids, flavonoids, and polyphenols, some of which play an important antiviral role. Herein, we present a background to viral central nervous system (CNS) infections, followed by a review of medicinal plants and bioactive compounds that are effective against viral pathogens in CNS infections. METHODS A comprehensive literature search was conducted on scientific databases including: PubMed, Scopus, Google Scholar, and Web of Science. The relevant keywords used as search terms were: "myelitis", "encephalitis", "meningitis", "meningoencephalitis", "encephalomyelitis", "central nervous system", "brain", "spinal cord", "infection", "virus", "medicinal plants", and "biological compounds". RESULTS The most significant viruses involved in central nervous system infections are: Herpes Simplex Virus (HSV), Varicella Zoster Virus (VZV), West Nile Virus (WNV), Enterovirus 71 (EV71), Japanese Encephalitis Virus (JEV), and Dengue Virus (DENV). The inhibitory activity of medicinal plants against CNS viruses is mostly active through prevention of viral binding to cell membranes, blocking viral genome replication, prevention of viral protein expression, scavenging reactive Oxygen Species (ROS), and reduction of plaque formation. CONCLUSION Due to the increased resistance of microorganisms (bacteria, viruses, and parasites) to antimicrobial therapies, alternative treatments, especially using plant sources and their bioactive constituents, appear to be more fruitful.
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Affiliation(s)
- Khojasteh Malekmohammad
- Department of Animal Sciences, Faculty of Basic Sciences, Shahrekord University, Shahrekord, Iran
| | - Mahmoud Rafieian-Kopaei
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Samira Sardari
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahrekord University, Shahrekord, Iran
| | - Robert D E Sewell
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff CF10 3NB, Wales, United Kingdom
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19
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Nguyen TTK, Ngo TT, Tran PM, Pham TTT, Vu HTT, Nguyen NTH, Thwaites G, Virtala AK, Vapalahti O, Baker S, Le Van T. Respiratory viruses in individuals with a high frequency of animal exposure in southern and highland Vietnam. J Med Virol 2020; 92:971-981. [PMID: 31769525 PMCID: PMC7228379 DOI: 10.1002/jmv.25640] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/22/2019] [Indexed: 12/23/2022]
Abstract
Active surveillance for zoonotic respiratory viruses is essential to inform the development of appropriate interventions and outbreak responses. Here we target individuals with a high frequency of animal exposure in Vietnam. Three-year community-based surveillance was conducted in Vietnam during 2013-2016. We enrolled a total of 581 individuals (animal-raising farmers, slaughterers, animal-health workers, and rat traders), and utilized reverse transcription-polymerase chain reaction to detect 15 common respiratory viruses in pooled nasal-throat swabs collected at baseline or acute respiratory disease episodes. A respiratory virus was detected in 7.9% (58 of 732) of baseline samples, and 17.7% (136 of 770) of disease episode samples (P < .001), with enteroviruses (EVs), rhinoviruses and influenza A virus being the predominant viruses detected. There were temporal and spatial fluctuations in the frequencies of the detected viruses over the study period, for example, EVs and influenza A viruses were more often detected during rainy seasons. We reported the detection of common respiratory viruses in individuals with a high frequency of animal exposure in Vietnam, an emerging infectious disease hotspot. The results show the value of baseline/control sampling in delineating the causative relationships and have revealed important insights into the ecological aspects of EVs, rhinoviruses and influenza A and their contributions to the burden posed by respiratory infections in Vietnam.
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Affiliation(s)
- Tu Thi Kha Nguyen
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Dong Thap Provincial Center for Disease ControlDong Thap ProvinceVietnam
| | - Tue Tri Ngo
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
| | - Phuc My Tran
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
| | | | - Hang Thi Ty Vu
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
| | | | - Guy Thwaites
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Centre for Tropical Medicine and Global HealthOxford UniversityOxfordUnited Kingdom
| | - Anna‐Maija K. Virtala
- Department of Veterinary Biosciences, Faculty of Veterinary MedicineUniversity of HelsinkiHelsinkiFinland
| | - Olli Vapalahti
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Department of Veterinary Biosciences, Faculty of Veterinary MedicineUniversity of HelsinkiHelsinkiFinland
- Department of Virology and ImmunologyHUSLAB, Helsinki University HospitalHelsinkiFinland
| | - Stephen Baker
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Centre for Tropical Medicine and Global HealthOxford UniversityOxfordUnited Kingdom
- Department of MedicineUniversity of CambridgeCambridgeUnited Kingdom
| | - Tan Le Van
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
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20
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Santoso LA, Widodo DP, Munasir Z. Factors associated with outcome of acute encephalitis in children: a retrospective study of three referral hospitals. MEDICAL JOURNAL OF INDONESIA 2020. [DOI: 10.13181/mji.oa.203651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Encephalitis is more frequent in children and has a poor outcome. There was no data on encephalitis in children in Indonesia, so this study was aimed to evaluate clinical presentation and diagnostic examination of children with acute encephalitis, and factors related to outcome.
METHODS This was a retrospective study of medical records between 2014 and 2018 in three referral hospitals in Jakarta and Tangerang. Clinical presentation at admission, cerebrospinal fluid analysis, neuroimaging, and electroencephalography (EEG) were documented. Outcome was determined at hospital discharge and classified as poor for severe neurological abnormalities at discharge or died. Logistic regression was used to evaluate associated factors with the outcome.
RESULTS A total of 190 children were included and most were age >1 year (71%). Most subjects presented with fever (90%) and seizures (87%). Of those who had seizures, 80% experienced generalized seizures. Focal neurological deficit was seen in 90 patients (47%). EEG was positive in 90% subjects (n = 27/30). Probable cases were found in 51% of all subjects. The mortality was 23%. Focal seizures (odds ratio [OR] = 3.305, 95% confidence interval [CI] = 1.122–9.742) and age >1 year (OR = 3.076, 95% CI = 1.388–6.803) were risk factors for a poor outcome.
CONCLUSIONS Acute encephalitis occurred most often in children aged >1 year. Fever and seizures were the most common symptoms. EEG was better than other examinations for confirming diagnosis of encephalitis. Focal seizures and age >1 year were associated with a three-fold increased risk for a poor outcome.
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21
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Ngwe Tun MM, Muthugala R, Nabeshima T, Soe AM, Dumre SP, Rajamanthri L, Jayawardana D, Attanayake S, Inoue S, Morita K. Complete genome analysis and characterization of neurotropic dengue virus 2 cosmopolitan genotype isolated from the cerebrospinal fluid of encephalitis patients. PLoS One 2020; 15:e0234508. [PMID: 32555732 PMCID: PMC7302667 DOI: 10.1371/journal.pone.0234508] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/26/2020] [Indexed: 01/18/2023] Open
Abstract
Dengue virus (DENV) infection remains a major public health concern in many parts of the world, including Southeast Asia and the Americas. Sri Lanka experienced its largest dengue outbreak in 2017. Neurological symptoms associated with DENV infection have increasingly been reported in both children and adults. Here, we characterize DENV type 2 (DENV-2) strains, which were isolated from cerebrospinal fluid (CSF) and/or serum of patients with dengue encephalitis. Acute serum and CSF samples from each patient were subjected to dengue-specific non-structural protein 1 (NS1) antigen test, IgM and IgG enzyme-linked immunosorbent assay (ELISA), virus isolation, conventional and real-time polymerase chain reaction (PCR), and next-generation sequencing (NGS). Among the 5 dengue encephalitis patients examined, 4 recovered and 1 died. DENV-2 strains were isolated from serum and/or CSF samples of 3 patients. The highest viral genome levels were detected in the CSF and serum of the patient who succumbed to the illness. A phylogenetic tree revealed that the DENV-2 isolates belonged to a new clade of cosmopolitan genotype and were genetically close to strains identified in China, South Korea, Singapore, Malaysia, Thailand, and the Philippines. According to the NGS analysis, greater frequencies of nonsynonymous and synonymous mutations per gene were identified in the nonstructural genes. The full genomes of serum- and CSF-derived DENV-2 from the same patient shared 99.7% similarity, indicating that the virus spread across the blood-brain barrier. This is the first report to describe neurotropic DENV-2 using whole-genome analysis and to provide the clinical, immunological, and virological characteristics of dengue encephalitis patients during a severe dengue outbreak in Sri Lanka in 2017.
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Affiliation(s)
- Mya Myat Ngwe Tun
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- * E-mail: (KM); (MMNT)
| | | | - Takeshi Nabeshima
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Aung Min Soe
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Shyam Prakash Dumre
- Department of Immunogenetics, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | | | | | | | - Shingo Inoue
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Kouichi Morita
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- * E-mail: (KM); (MMNT)
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22
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Xing XW, Zhang JT, Ma YB, He MW, Yao GE, Wang W, Qi XK, Chen XY, Wu L, Wang XL, Huang YH, Du J, Wang HF, Wang RF, Yang F, Yu SY. Metagenomic Next-Generation Sequencing for Diagnosis of Infectious Encephalitis and Meningitis: A Large, Prospective Case Series of 213 Patients. Front Cell Infect Microbiol 2020; 10:88. [PMID: 32211343 PMCID: PMC7066979 DOI: 10.3389/fcimb.2020.00088] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/19/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose: We assessed the performance of metagenomic next-generation sequencing (mNGS) in the diagnosis of infectious encephalitis and meningitis. Methods: This was a prospective multicenter study. Cerebrospinal fluid samples from patients with viral encephalitis and/or meningitis, tuberculous meningitis, bacterial meningitis, fungal meningitis, and non-central nervous system (CNS) infections were subjected to mNGS. Results: In total, 213 patients with infectious and non-infectious CNS diseases were finally enrolled from November 2016 to May 2019; the mNGS-positive detection rate of definite CNS infections was 57.0%. At a species-specific read number (SSRN) ≥2, mNGS performance in the diagnosis of definite viral encephalitis and/or meningitis was optimal (area under the curve [AUC] = 0.659, 95% confidence interval [CI] = 0.566–0.751); the positivity rate was 42.6%. At a genus-specific read number ≥1, mNGS performance in the diagnosis of tuberculous meningitis (definite or probable) was optimal (AUC=0.619, 95% CI=0.516–0.721); the positivity rate was 27.3%. At SSRNs ≥5 or 10, the diagnostic performance was optimal for definite bacterial meningitis (AUC=0.846, 95% CI = 0.711–0.981); the sensitivity was 73.3%. The sensitivities of mNGS (at SSRN ≥2) in the diagnosis of cryptococcal meningitis and cerebral aspergillosis were 76.92 and 80%, respectively. Conclusion: mNGS of cerebrospinal fluid effectively identifies pathogens causing infectious CNS diseases. mNGS should be used in conjunction with conventional microbiological testing. Trial Registration: Chinese Clinical Trial Registry, ChiCTR1800020442.
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Affiliation(s)
- Xiao-Wei Xing
- Department of Neurology, Hainan Hospital of PLA General Hospital, Sanya, China
| | - Jia-Tang Zhang
- Department of Neurology, First Medical Center of PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Yu-Bao Ma
- Department of Neurology, First Medical Center of PLA General Hospital, Beijing, China
| | - Mian-Wang He
- Department of Neurology, First Medical Center of PLA General Hospital, Beijing, China
| | - Guo-En Yao
- Department of Neurology, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Wei Wang
- Department of Neurology, Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Xiao-Kun Qi
- Department of Neurology, Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Xiao-Yan Chen
- Department of Neurology, First Medical Center of PLA General Hospital, Beijing, China
| | - Lei Wu
- Department of Neurology, First Medical Center of PLA General Hospital, Beijing, China
| | - Xiao-Lin Wang
- Department of Neurology, First Medical Center of PLA General Hospital, Beijing, China
| | - Yong-Hua Huang
- Department of Neurology, Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Juan Du
- Department of Neurology, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Hong-Fen Wang
- Department of Neurology, First Medical Center of PLA General Hospital, Beijing, China
| | - Rong-Fei Wang
- Department of Neurology, First Medical Center of PLA General Hospital, Beijing, China
| | - Fei Yang
- Department of Neurology, First Medical Center of PLA General Hospital, Beijing, China
| | - Sheng-Yuan Yu
- Department of Neurology, First Medical Center of PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
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23
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Hudson JA, Broad J, Martin NG, Sadarangani M, Galal U, Kelly DF, Pollard AJ, Kadambari S. Outcomes beyond hospital discharge in infants and children with viral meningitis: A systematic review. Rev Med Virol 2019; 30:e2083. [PMID: 31524309 DOI: 10.1002/rmv.2083] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/18/2019] [Accepted: 08/27/2019] [Indexed: 12/27/2022]
Abstract
Viruses are the commonest cause of childhood meningitis, but outcomes beyond hospital discharge are poorly described. We undertook a systematic literature review of long-term outcomes following paediatric viral meningitis. A search was carried out using MEDLINE, Embase, and Cochrane Review for studies from 1 January 1990 to 31 December 2018. Studies were included where specific outcome measures were available beyond hospital discharge for children <16 years old with viral meningitis. In total, 3588 papers were identified of which 14 were eligible for inclusion. Four studies reported outcomes in children with nonenterovirus 71 meningitis. A US study of 16 cases demonstrated subtle language difficulties at 3-year follow-up in infants in contrast to an Australian study, which revealed no impairment in language. A Fijian study showed that two out of eight cases had sensorineural hearing loss compared with none in a UK cohort of 668 infants. Three studies evaluated outcomes of enterovirus 71 meningitis in China and Taiwan, two showed cases recovered without sequelae, while one demonstrated an increased risk of attention deficit hyperactivity disorder. Two studies including 141 cases of human parechovirus revealed no evidence of neurodevelopmental sequelae. Conversely, an Australian study demonstrated neurodevelopmental sequelae in 11 out of 77 infants with parechovirus meningitis. Most studies identified in this review demonstrated a high proportion of good clinical outcomes following viral meningitis. However, the data are limited, so robustly conducted neurodevelopmental studies are warranted to inform the evidence-based management of viral meningitis beyond hospital discharge.
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Affiliation(s)
- Jessica A Hudson
- Department of Public Health, John Radcliffe Hospital, Oxford, UK
| | - Jonathan Broad
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Natalie G Martin
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada
| | - Ushma Galal
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Dominic F Kelly
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Seilesh Kadambari
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
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24
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Vasanthapuram R, Shahul Hameed SK, Desai A, Mani RS, Reddy V, Velayudhan A, Yadav R, Jain A, Saikia L, Borthakur A, Mohan DG, Bandyopadhyay B, Bhattacharya N, Dhariwal AC, Sen PK, Venkatesh S, Prasad J, Laserson K, Srikantiah P. Dengue virus is an under-recognised causative agent of acute encephalitis syndrome (AES): Results from a four year AES surveillance study of Japanese encephalitis in selected states of India. Int J Infect Dis 2019; 84S:S19-S24. [DOI: 10.1016/j.ijid.2019.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/02/2019] [Accepted: 01/04/2019] [Indexed: 10/27/2022] Open
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25
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Turtle L, Brindle HE, Schluter WW, Faragher B, Rayamajhi A, Bohara R, Gurung S, Shakya G, Yoksan S, Dixit S, Rajbhandari R, Paudel B, Adhikari S, Solomon T, Griffiths MJ. Low population Japanese encephalitis virus (JEV) seroprevalence in Udayapur district, Nepal, three years after a JE vaccination programme: A case for further catch up campaigns? PLoS Negl Trop Dis 2019; 13:e0007269. [PMID: 30986252 PMCID: PMC6483279 DOI: 10.1371/journal.pntd.0007269] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 04/25/2019] [Accepted: 02/27/2019] [Indexed: 02/07/2023] Open
Abstract
The live attenuated Japanese encephalitis (JE) vaccine SA14-14-2 has been used in Nepal for catch-up campaigns and is now included in the routine immunisation schedule. Previous studies have shown good vaccine efficacy after one dose in districts with a high incidence of JE. The first well-documented dengue outbreak occurred in Nepal in 2006 with ongoing cases now thought to be secondary to migration from India. Previous infection with dengue virus (DENV) partially protects against JE and might also influence serum neutralising antibody titres against JEV. This study aimed to determine whether serum anti-JEV neutralisation titres are: 1. maintained over time since vaccination, 2. vary with historic local JE incidence, and 3. are associated with DENV neutralising antibody levels. We conducted a cross-sectional study in three districts of Nepal: Banke, Rupandehi and Udayapur. Udayapur district had been vaccinated against JE most recently (2009), but had been the focus of only one campaign, compared with two in Banke and three in Rupandehi. Participants answered a short questionnaire and serum was assayed for anti-JEV and anti-DENV IgM and IgG (by ELISA) and 50% plaque reduction neutralisation titres (PRNT50) against JEV and DENV serotypes 1–4. A titre of ≥1:10 was considered seropositive to the respective virus. JEV neutralising antibody seroprevalence (PRNT50 ≥ 1:10) was 81% in Banke and Rupandehi, but only 41% in Udayapur, despite this district being vaccinated more recently. Sensitivity of ELISA for both anti-JEV and anti-DENV antibodies was low compared with PRNT50. DENV neutralising antibody correlated with the JEV PRNT50 ≥1:10, though the effect was modest. IgM (indicating recent infection) against both viruses was detected in a small number of participants. We also show that DENV IgM is present in Nepali subjects who have not travelled to India, suggesting that DENV may have become established in Nepal. We therefore propose that further JE vaccine campaigns should be considered in Udayapur district, and similar areas that have had fewer vaccination campaigns. In Nepal, immunisation using a live attenuated vaccine is given against Japanese encephalitis (JE), caused by the mosquito-transmitted JE virus (JEV). JE immunisation has taken place via catch-up campaigns and is now part of the routine immunisation programme. Although previous studies have shown good vaccine efficacy in areas where there is a lot of natural exposure to the virus (high endemicity), it is suggested that the efficacy may wane in areas where transmission is lower. Dengue virus (DENV) belongs to the same family and genus as JEV. Previous infection with DENV may also influence the immune response to JEV. Therefore, we conducted a cross-sectional study in Nepal to measure immunity to JE, in districts of differing historic JE incidence, and time from JE vaccination. This showed that neutralising antibody to JEV was found more frequently in districts which had been the subject of more vaccination campaigns, rather than in the most recently vaccinated district. In addition, we cannot rule out a role for natural exposure to JEV in maintaining higher antibody levels. Additionally, the study showed that previous exposure to DENV was positively associated with an immune response to JEV, though this effect was modest. We conclude that there is a need to consider further JE vaccine catch up campaigns in some areas especially given that we could detect JEV IgM, indicating ongoing transmission. We show that ELISA yielded many false negative results for exposure to JEV or vaccination, when compared with neutralising antibody. We also identified some individuals during the course of the study with DENV IgM in their blood, but with no history of travel to India. This suggests that DENV may have become established in some areas of Nepal.
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Affiliation(s)
- Lance Turtle
- Institute of Infection and Global Health and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals, members of Liverpool Health Partners, Liverpool, United Kingdom
| | - Hannah E Brindle
- Institute of Infection and Global Health and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, United Kingdom.,Oxford University Clinical Research Unit, Ha Noi, Viet Nam
| | | | - Brian Faragher
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ajit Rayamajhi
- Kanti Children's Hospital, Maharajgunj, Kathmandu, Nepal.,National Academy of Medical Sciences, Kathmandu, Nepal
| | | | | | - Geeta Shakya
- National Public Health Laboratory, Teku, Kathmandu, Nepal
| | - Sutee Yoksan
- Institute of Molecular Biosciences, Mahidol University and Translational Research Unit, Chulabhorn Research Institute, Bangkok, Thailand
| | - Sameer Dixit
- Center for Molecular Dynamics Nepal, Thapathali, Kathmandu, Nepal
| | | | - Bimal Paudel
- National Public Health Laboratory, Teku, Kathmandu, Nepal
| | | | - Tom Solomon
- Institute of Infection and Global Health and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, United Kingdom.,Walton Centre NHS Foundation Trust, member of Liverpool Health Partners, Liverpool, United Kingdom
| | - Mike J Griffiths
- Institute of Infection and Global Health and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, United Kingdom.,Alder Hey Children's NHS Trust, member of Liverpool Health Partners, Liverpool, United Kingdom
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26
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Phan NT, Gouilh MA, Paireau J, Phuong L, Cheval J, Ngu ND, Hébert C, Nguyen TH, Lortholary O, Tondeur L, Manuguerra JC, Barouki R, Sander J, Janzen N, Nguyen HT, Brey PT, Fontanet A, Eloit M. Hypoglycemic Toxins and Enteroviruses as Causes of Outbreaks of Acute Encephalitis-Like Syndrome in Children, Bac Giang Province, Northern Vietnam. Emerg Infect Dis 2019; 24:1435-1443. [PMID: 30014832 PMCID: PMC6056107 DOI: 10.3201/eid2408.171004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We investigated the cause of seasonal outbreaks of pediatric acute encephalitis-like syndrome associated with litchi harvests (May–July) in northern Vietnam since 2008. Nineteen cerebrospinal fluid samples were positive for human enterovirus B, and 8 blood samples were positive for hypoglycemic toxins present in litchi fruits. Patients who were positive for hypoglycemic toxins had shorter median times between disease onset and admission, more reports of seizures, more reports of hypoglycemia (glucose level <3 mmol/L), lower median numbers of leukocytes in cerebrospinal fluid, and higher median serum levels of alanine aminotransferase and aspartate transaminase than did patients who were positive for enteroviruses. We suggest that children with rapidly progressing acute encephalitis-like syndrome at the time of the litchi harvest have intoxication caused by hypoglycemic toxins, rather than viral encephalitis, as previously suspected. These children should be urgently treated for life-threatening hypoglycemia.
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27
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Ferreira JE, Ferreira SC, Almeida-Neto C, Nishiya AS, Alencar CS, Gouveia GR, Caiaffa-Filho H, Gomes H, de Macedo Santos RT, Witkin SS, Mendrone-Junior A, Sabino EC. Molecular characterization of viruses associated with encephalitis in São Paulo, Brazil. PLoS One 2019; 14:e0209993. [PMID: 30640927 PMCID: PMC6331147 DOI: 10.1371/journal.pone.0209993] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/14/2018] [Indexed: 01/01/2023] Open
Abstract
The objective of this study was to characterize the prevalence of viral encephalitis due to arbovirus infection of the Togaviridae and Flaviviridae families in São Paulo, Brazil. A total of 500 cerebrospinal fluid (CSF) samples collected between August 2012 and January 2013, from patients with symptoms of acute encephalitis were analyzed. Findings suggestive of viral encephalitis-elevations in cell concentration, glucose and total protein-were observed in 234 (46.8%) samples, designated as Group 1. The remaining 266 samples comprised Group 2. All samples were tested for Flaviviruses (dengue virus 1, 2, 3 and 4, yellow fever virus and West Nile virus), Alphavirus (NS5 region) and enterovirus by RT- PCR and for herpesviruses and enteroviruses using CLART-Entherpex. A presumptive viral etiological agent was detected in 26 samples (5.2%), 18 (8.0%) in Group 1 and 8 (3.0%) in Group 2. In Group 1 human herpesviruses were detected in 9 cases, enteroviruses in 7 cases, dengue viruses (DENV) in 2 CSFs and St. Louis encephalitis virus (SLEV) in one case. In Group 2 there were 3 CSFs positive for human herpesviruses, 2 for enteroviruses, 2 for DENV and 1 for SLEV. Detection of arboviruses, even though present in a minority of infected patients, identifies these viruses as a probable etiological agent of encephalitis. This is of special concern in regions where this class of viruses is endemic and has been linked to other recent epidemics.
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Affiliation(s)
- Jerenice E. Ferreira
- LIM / 46—Laboratory of Medical Parasitology, Institute of Tropical Medicine—IMT, University of São Paulo Medical School USP, São Paulo, Brazil
- Pathology Center, Adolf Lutz Institute–IAL, São Paulo, Brazil
| | | | - Cesar Almeida-Neto
- Fundação Pró-Sangue Hemocentro de São Paulo–FPS/HSP, São Paulo, Brazil
- Disciplina de Ciências Médicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Anna S. Nishiya
- Fundação Pró-Sangue Hemocentro de São Paulo–FPS/HSP, São Paulo, Brazil
| | - Cecilia S. Alencar
- Central Laboratory Division—Hospital das Clínicas São Paulo–DLC-HCSP
- Clinical Laboratory and LIM 03–Department of Pathology, Clinical Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - Gisele R. Gouveia
- Faculty of Medicine, University of São Paulo–FMUSP, São Paulo, Brazil
| | - Helio Caiaffa-Filho
- Pathology Center, Adolf Lutz Institute–IAL, São Paulo, Brazil
- Central Laboratory Division—Hospital das Clínicas São Paulo–DLC-HCSP
| | - Helio Gomes
- Central Laboratory Division—Hospital das Clínicas São Paulo–DLC-HCSP
- Clinical Laboratory and LIM 03–Department of Pathology, Clinical Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Steven S. Witkin
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States of America
| | | | - Ester C. Sabino
- LIM / 46—Laboratory of Medical Parasitology, Institute of Tropical Medicine—IMT, University of São Paulo Medical School USP, São Paulo, Brazil
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28
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Nelson C, Mori N, Ton T, Zunt J, Kochel T, Romero A, Gadea N, Tilley D, Ticona E, Soria J, Celis V, Huanca D, Delgado A, Rivas M, Stiglich M, Sihuincha M, Donayre G, Celis J, Romero R, Tam N, Tipismana M, Espinoza I, Rozas M, Peralta A, Sanchez E, Vasquez L, Muñoz P, Ramirez G, Reyes I. Building a network for multicenter, prospective research of central nervous system infections in South America: Process and lessons learned. eNeurologicalSci 2018; 13:63-69. [PMID: 30547106 PMCID: PMC6284170 DOI: 10.1016/j.ensci.2018.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 03/01/2018] [Accepted: 07/03/2018] [Indexed: 11/21/2022] Open
Abstract
Multicenter collaborative networks are essential for advancing research and improving clinical care for a variety of conditions. Research networks are particularly important for central nervous system infections, which remain difficult to study due to their sporadic occurrence and requirement for collection and testing of cerebrospinal fluid. Establishment of long-term research networks in resource-limited areas also facilitates diagnostic capacity building, surveillance for emerging pathogens, and provision of appropriate treatment where needed. We review our experience developing a research network for encephalitis among twelve hospitals in five Peruvian cities since 2009. We provide practical suggestions to aid other groups interested in advancing research on central nervous system infections in resource-limited areas.
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Affiliation(s)
- Christina Nelson
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Nicanor Mori
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
- US Naval Medical Research Unit-6, Callao, Peru
| | - Thanh Ton
- Department of Neurology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Joseph Zunt
- Department of Neurology, School of Medicine, University of Washington, Seattle, WA, USA
- Departments of Global Health and Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | | | - T. Kochel
- US Naval Medical Research Unit-6, Callao, Peru
| | - A. Romero
- US Naval Medical Research Unit-6, Callao, Peru
| | - N. Gadea
- US Naval Medical Research Unit-6, Callao, Peru
| | - D. Tilley
- US Naval Medical Research Unit-6, Callao, Peru
| | | | - J. Soria
- Dos de Mayo Hospital, Lima, Peru
| | | | - D. Huanca
- Hospital Edgardo Rebagliati Martins, Lima, Peru
| | - A. Delgado
- Hospital Edgardo Rebagliati Martins, Lima, Peru
| | - M. Rivas
- Hospital San Bartolome, Lima, Peru
| | | | | | - G. Donayre
- Hospital Felipe Santiago Arriola Iglesias, Loreto, Peru
| | - J. Celis
- Hospital Felipe Santiago Arriola Iglesias, Loreto, Peru
| | - R. Romero
- Hospital Daniel Alcides Carrion, Callao, Peru
| | - N. Tam
- Hospital Daniel Alcides Carrion, Callao, Peru
| | | | | | - M. Rozas
- Hospital Regional Cusco, Cusco, Peru
| | - A. Peralta
- Hospital Carlos Alberto Seguin, Arequipa, Peru
| | | | | | - P. Muñoz
- Hospital Hipolito Unanue, Lima, Peru
| | - G. Ramirez
- Hospital Emergencias Pediatricas, Lima, Peru
| | - I. Reyes
- Hospital Emergencias Pediatricas, Lima, Peru
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Detection of central nervous system viral infections in adults in Manado, North Sulawesi, Indonesia. PLoS One 2018; 13:e0207440. [PMID: 30444898 PMCID: PMC6239303 DOI: 10.1371/journal.pone.0207440] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/31/2018] [Indexed: 02/08/2023] Open
Abstract
Central nervous system (CNS) viral infections are important causes of morbidity and mortality worldwide but the systematic survey of patients admitted to hospitals with CNS infections in many countries, including Indonesia, is limited. To obtain more information regarding the causes of CNS infections in Indonesia, this study was performed to detect and identify viral agents associated with CNS infections amongst in-patients at a referral hospital in Manado, North Sulawesi, Indonesia. Adult patients admitted to R.D. Kandou General Hospital with presumed CNS infection were enrolled. Cerebrospinal fluid, serum, and throat swab samples were collected and tested using molecular, serological, and virus isolation assays. A confirmed viral etiology was established in three and a probable/possible in 11 out of 74 patients. The most common was herpes simplex virus 1 (7/74, 9.5%), followed by Epstein-Barr virus (2/74, 2.7%), cytomegalovirus (1/74, 1.4%), enterovirus D68 (1/74, 1.4%), rhinovirus A (1/74, 1.4%), dengue virus (1/64, 1.6%), and Japanese encephalitis virus (1/64, 1.6%). There were 20 fatal cases (27.0%) during hospitalization in which eight were associated with viral causes. We identified herpes simplex virus 1 as the most common cause of CNS infection among adults in North Sulawesi with most of the cases remaining undiagnosed. Our study highlights the challenges in establishing the etiology of viral CNS infections and the importance of using a wide range of molecular and serological detection methods to identify CNS viruses.
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Chen W, Su Y, Jiang M, Liu G, Tian F, Ren G. Status epilepticus associated with acute encephalitis: long‐term follow‐up of functional and cognitive outcomes in 72 patients. Eur J Neurol 2018; 25:1228-1234. [PMID: 29751371 DOI: 10.1111/ene.13678] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 05/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- W. Chen
- Department of Neurology Xuanwu Hospital Capital Medical University Beijing China
| | - Y. Su
- Department of Neurology Xuanwu Hospital Capital Medical University Beijing China
| | - M. Jiang
- Department of Neurology Xuanwu Hospital Capital Medical University Beijing China
| | - G. Liu
- Department of Neurology Xuanwu Hospital Capital Medical University Beijing China
| | - F. Tian
- Department of Neurology Xuanwu Hospital Capital Medical University Beijing China
| | - G. Ren
- Department of Neurology Xuanwu Hospital Capital Medical University Beijing China
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Ben Abid F, Abukhattab M, Ghazouani H, Khalil O, Gohar A, Al Soub H, Al Maslamani M, Al Khal A, Al Masalamani E, Al Dhahry S, Hashim S, Howadi F, Butt AA. Epidemiology and clinical outcomes of viral central nervous system infections. Int J Infect Dis 2018; 73:85-90. [PMID: 29913285 DOI: 10.1016/j.ijid.2018.06.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 05/31/2018] [Accepted: 06/11/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Central nervous system (CNS) viral infections are an important cause of morbidity and mortality. No data are available regarding their epidemiology in Qatar. DESIGN We retrospectively evaluated all cerebrospinal fluid findings from January 2011-March 2015 at Hamad Medical Corporation. Those with abnormal CSF finding were included in our study. We excluded those with missing medical records, no clinical evidence of viral CNS infection, or proven bacterial, fungal or tuberculosis CNS infection. CNS clinical findings were classified as meningitis, encephalitis or myelitis. RESULTS Among 7690 patients with available CSF results, 550 cases met the inclusion criteria (meningitis 74.7%; encephalitis 25%; myelitis 0.4%). Two-thirds (65%) were male and 50% were between 16-60 years old. Viral etiology was confirmed in 38% (enterovirus, 44.3%; Epstein-Barr virus, 31%; varicella zoster virus, 12.4%). The estimated incidence was 6.4 per 100,000 population. Two persons died and the rest were discharged to home. Among those with confirmed viral etiology, 83.8% received ceftriaxone (mean duration 7.3±5.2 days), 38% received vancomycin (mean duration 2.7±5.4 days) and 38% received at least one other antibiotic. Intravenous acyclovir was continued for more than 48h in patients with confirmed negative viral etiology (mean duration 5±5.6 days). CONCLUSION Viral etiology is not uncommon among those evaluated for CNS infection in Qatar. Clinical outcomes are excellent in this group of patients. Antibiotics and acyclovir are overly used even when a viral etiology is confirmed. There is a need for clinician education regarding etiology and treatment of viral CNS infections.
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Affiliation(s)
- Fatma Ben Abid
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar.
| | - Mohammed Abukhattab
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | - Hafedh Ghazouani
- Department of Bioinformatics, Department of Medical Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Obada Khalil
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Gohar
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | - Hussam Al Soub
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College, New York, NY, USA and Doha, Qatar
| | - Muna Al Maslamani
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College, New York, NY, USA and Doha, Qatar
| | - Abdullatif Al Khal
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College, New York, NY, USA and Doha, Qatar
| | - Eman Al Masalamani
- Department of Pediatrics, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | - Said Al Dhahry
- Department of Laboratory Medicine and Pathology, Section of Virology and Molecular Biology, Hamad Medical Corporation, Doha, Qatar
| | - Samar Hashim
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | - Faraj Howadi
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | - Adeel A Butt
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College, New York, NY, USA and Doha, Qatar
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Chen X, Guo J, Li J, Li Q, Ai J, Sun S, Xie Z. Serotypes of human enteroviruses causing pediatric viral encephalitis and meningitis in Hebei province, China, from 2013 to 2015. Pediatr Investig 2018; 2:98-104. [PMID: 32851241 PMCID: PMC7331305 DOI: 10.1002/ped4.12037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/05/2018] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Viral encephalitis and meningitis are severe infectious diseases responsible for substantial morbidity and mortality in children. Enteroviruses are typically the most common causative agents of viral encephalitis and meningitis. OBJECTIVE This study aimed to investigate the etiology of viral encephalitis and meningitis among children in Hebei province, China. METHODS Cerebrospinal fluid samples from children with viral encephalitis (n=309) and meningitis (n=133) were collected between Nov 2013 and Dec 2015 and viral pathogens were identified by real-time and multiplex PCR. Amplification and sequencing of partial VP1 genes was used to type enteroviruses. RESULTS The causative pathogen was successfully detected in 176 (57%) patients with viral encephalitis and 82 (61.7%) patients with viral meningitis. The most common causative agents of both viral encephalitis and meningitis were enteroviruses (55.7% and 64.6% of cases, respectively). The most common enterovirus serotypes identified were echovirus 18, echovirus 6 and echovirus 30. Echovirus 18 accounted for 74.4% of all typed enteroviruses and caused a viral encephalitis and meningitis outbreak in Hebei province in 2015. By contrast, the major enterovirus serotypes circulating in 2014 were echovirus 6 and echovirus 30. INTERPRETATION Enteroviruses were the main causative agents of viral encephalitis and meningitis in children in Hebei province from Nov 2013 to Dec 2015. Echovirus 18 became the leading cause of viral encephalitis and meningitis for the first time in Hebei province in 2015.
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Affiliation(s)
- Xiangpeng Chen
- Key Laboratory of Major Diseases in ChildrenMinistry of EducationBeijing Key Laboratory of Pediatric Respiratory Infection DiseasesVirology LaboratoryBeijing Pediatric Research InstituteBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Jiayun Guo
- Key Laboratory of Major Diseases in ChildrenMinistry of EducationBeijing Key Laboratory of Pediatric Respiratory Infection DiseasesVirology LaboratoryBeijing Pediatric Research InstituteBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Jingjie Li
- Department of NeurologyChildren's Hospital of Hebei ProvinceShijiazhuangChina
| | - Qiuping Li
- Key Laboratory of Major Diseases in ChildrenMinistry of EducationBeijing Key Laboratory of Pediatric Respiratory Infection DiseasesVirology LaboratoryBeijing Pediatric Research InstituteBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Junhong Ai
- Key Laboratory of Major Diseases in ChildrenMinistry of EducationBeijing Key Laboratory of Pediatric Respiratory Infection DiseasesVirology LaboratoryBeijing Pediatric Research InstituteBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Suzhen Sun
- Department of NeurologyChildren's Hospital of Hebei ProvinceShijiazhuangChina
| | - Zhengde Xie
- Key Laboratory of Major Diseases in ChildrenMinistry of EducationBeijing Key Laboratory of Pediatric Respiratory Infection DiseasesVirology LaboratoryBeijing Pediatric Research InstituteBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
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B'Krong NTTC, Minh NNQ, Qui PT, Chau TTH, Nghia HDT, Do LAH, Nhung NN, Van Vinh Chau N, Thwaites G, Van Tan L, van Doorn HR, Thanh TT. Enterovirus serotypes in patients with central nervous system and respiratory infections in Viet Nam 1997-2010. Virol J 2018; 15:69. [PMID: 29650033 PMCID: PMC5897964 DOI: 10.1186/s12985-018-0980-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/07/2018] [Indexed: 11/24/2022] Open
Abstract
Background Enteroviruses are the most common causative agents of human illness. Enteroviruses have been associated with regional and global epidemics, recently, including with severe disease (Enterovirus A71 and D68), and are of interest as emerging viruses. Here, we typed Enterovirus A-D (EV) from central nervous system (CNS) and respiratory infections in Viet Nam. Methods Data and specimens from prospective observational clinical studies conducted between 1997 and 2010 were used. Species and serotypes were determined using type-specific RT-PCR and viral protein 1 or 4 (VP1, VP4) sequencing. Results Samples from patients with CNS infection (51 children – 10 CSF and 41 respiratory/rectal swabs) and 28 adults (28 CSF) and respiratory infection (124 children – 124 respiratory swabs) were analysed. Twenty-six different serotypes of the four Enterovirus species (A-D) were identified, including EV-A71 and EV-D68. Enterovirus B was associated with viral meningitis in children and adults. Hand, foot and mouth disease associated Enteroviruses A (EV-A71 and Coxsackievirus [CV] A10) were detected in children with encephalitis. Diverse serotypes of all four Enterovirus species were found in respiratory samples, including 2 polio-vaccine viruses, but also 8 CV-A24 and 8 EV-D68. With the exception of EV-D68, the relevance of these viruses in respiratory infection remains unknown. Conclusion We describe the diverse spectrum of enteroviruses from patients with CNS and respiratory infections in Viet Nam between 1997 and 2010. These data confirm the global circulation of Enterovirus genera and their associations and are important for clinical diagnostics, patient management, and outbreak response. Electronic supplementary material The online version of this article (10.1186/s12985-018-0980-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nguyen Thi Thuy Chinh B'Krong
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam.,Division of Medicine and Laboratory Science, University of Oslo, Oslo, Norway
| | - Ngo Ngoc Quang Minh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam.,Children's Hospital 1, Ho Chi Minh City, Viet Nam
| | - Phan Tu Qui
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam.,Children's Hospital 1, Ho Chi Minh City, Viet Nam.,Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Tran Thi Hong Chau
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam.,Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Ho Dang Trung Nghia
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam.,Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Lien Anh Ha Do
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Nguyen Ngoc Nhung
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam.,Department of Biotechnology, University of Science, Ho Chi Minh City, Viet Nam
| | | | - Guy Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK. .,Oxford University Clinical Research Unit, 78 Giai Phong, Dong Da, Ha Noi, Viet Nam.
| | - Tran Tan Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam.
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Meligy B, Kadry D, Draz IH, Marzouk H, El Baroudy NR, El Rifay AS. Epidemiological Profile of Acute Viral Encephalitis in a Sample of Egyptian Children. Open Access Maced J Med Sci 2018; 6:423-429. [PMID: 29531617 PMCID: PMC5839461 DOI: 10.3889/oamjms.2018.103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/03/2018] [Accepted: 02/09/2018] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Acute encephalitis syndrome (AES) is a considerable public health problem. AIM This study was designed to describe the aetiology, demographic features, clinical picture, short-term outcome and risk factors of mortality of children with viral encephalitis in Egyptian children. METHODS PCR detection of viruses in the CSF of pediatric patients admitted to the pediatric unit or ICU Cairo University Pediatric hospital presenting with encephalitis syndrome. RESULTS Of the 96 patients included in the study, viral etiological agents were detected in 20 cases (20.8%), while 76 patients (79.2%) had no definite viral aetiology. The most abundant virus detected was Enterovirus (EV) in fourteen (14.5%), two (2.1%) were positive for human herpes simplex virus 6 (HSV-6), one (1.0%), human herpes simplex virus1 (HSV-1), one (1.0%) Epstein Barr virus (EBV), one (1.0%), cytomegalovirus (CMV) and one (1.0%) with varicella-zoster virus (VZV). On the short term outcome, 22 (22.9) patients died, and 74 (77.1%) survived. Severity outcome among survival was vegetative in three cases (4%) severe in 9 (12.16%), moderate in 14 (18.9%), mild in 29 (39.2%) and full recovery in 19 (25.6%). Mortality risk factors for younger age, the presence of apnea, the need for mechanical ventilation and the presence of abnormal CT findings were all significantly associated with fatal outcome (p < 0.05). CONCLUSION Enterovirus was the most common cause of encephalitis among Egyptian children. Mortality was correlated with younger age and disease severity at admission. Sequelae were high among infected children.
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Affiliation(s)
- Bassant Meligy
- Department of Paediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Kadry
- Department of Microbiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Iman H. Draz
- Department of Paediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Huda Marzouk
- Department of Paediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
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Tiwari JK, Malhotra B, Chauhan A, Malhotra H, Sharma P, Deeba F, Trivedi K, Swamy AM. Aetiological study of viruses causing acute encephalitis syndrome in North West India. Indian J Med Microbiol 2018; 35:529-534. [PMID: 29405145 DOI: 10.4103/ijmm.ijmm_17_180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
CONTEXT Acute encephalitis syndrome (AES) is a serious public health problem, caused mainly by viruses. However, the profile of viruses causing AES in Rajasthan is not well characterised. AIMS The present study was undertaken to identify the viruses causing AES and develop diagnostic algorithm so as to help in improved diagnosis, treatment, prevention and control. SETTINGS AND DESIGN The present study is a hospital-based descriptive, observational study. Samples were processed at Grade-1 DHR/ICMR Viral Research and Diagnostic Laboratory at SMS, Jaipur. SUBJECTS AND METHODS Cerebrospinal fluid (CSF) samples were processed for IgM antibody detection by enzyme-linked immunosorbent assay (ELISA) for mumps virus (MPV), measles virus (MV), Rubella virus (RV), Japanese encephalitis virus (JEV), West Nile virus (WNV) and Dengue virus using commercial kits. Nucleic acid was extracted from CSF using automated extraction system. Real-time polymerase chain reaction was done using specific primers and probes for Herpes simplex virus (HSV), Varicella-zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV) and enterovirus (EV). STATISTICAL ANALYSIS USED Statistical analysis was done using ANOVA. RESULTS Among 3088 patients, 702 (22.7%) patients were positive for one or more viruses. HSV (261;8.45%) was the most common followed by EBV (173;5.6%), VZV (97;3.1%), CMV (68;2.2%), EV (32;1.03%), MPV (27;0.9%), DV (28;0.9%), MV (19;0.6%) and RV (6;0.2%). CONCLUSIONS AES occurred sporadically in Rajasthan, samples should be tested first for herpes group of viruses followed by EV or/and for arboviruses depending on season or measles, mumps and RVs in children.
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Affiliation(s)
- Jitendra Kumar Tiwari
- Department of Microbiology and Immunology, Advanced Basic Sciences and Clinical Research Laboratory, ICMR Grade 1/ DHR State, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Bharti Malhotra
- Department of Microbiology and Immunology, Advanced Basic Sciences and Clinical Research Laboratory, ICMR Grade 1/ DHR State, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Aradhana Chauhan
- Department of Microbiology and Immunology, Advanced Basic Sciences and Clinical Research Laboratory, ICMR Grade 1/ DHR State, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Hemant Malhotra
- Department of Medicine, Sawai Man Singh Hospital, Jaipur, Rajasthan, India
| | - Pratibha Sharma
- Department of Microbiology and Immunology, Advanced Basic Sciences and Clinical Research Laboratory, ICMR Grade 1/ DHR State, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Farah Deeba
- Department of Microbiology and Immunology, Advanced Basic Sciences and Clinical Research Laboratory, ICMR Grade 1/ DHR State, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Khushbu Trivedi
- Department of Microbiology and Immunology, Advanced Basic Sciences and Clinical Research Laboratory, ICMR Grade 1/ DHR State, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Anjenya M Swamy
- Department of Microbiology and Immunology, Advanced Basic Sciences and Clinical Research Laboratory, ICMR Grade 1/ DHR State, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
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Turner P, Suy K, Tan LV, Sar P, Miliya T, Hong NTT, Hang VTT, Ny NTH, Soeng S, Day NPJ, van Doorn HR, Turner C. The aetiologies of central nervous system infections in hospitalised Cambodian children. BMC Infect Dis 2017; 17:806. [PMID: 29284418 PMCID: PMC5747189 DOI: 10.1186/s12879-017-2915-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 12/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Central nervous system (CNS) infections are an important cause of childhood morbidity and mortality. The aetiologies of these potentially vaccine-preventable infections have not been well established in Cambodia. METHODS We did a one year prospective study of children hospitalised with suspected CNS infection at Angkor Hospital for Children, Siem Reap. Cerebrospinal fluid specimens (CSF) samples underwent culture, multiplex PCR and serological analysis to identify a range of bacterial and viral pathogens. Viral metagenomics was performed on a subset of pathogen negative specimens. RESULTS Between 1st October 2014 and 30th September 2015, 284 analysable patients were enrolled. The median patient age was 2.6 years; 62.0% were aged <5 years. CSF white blood cell count was ≥10 cells/μL in 116/272 (42.6%) cases. CNS infection was microbiologically confirmed in 55 children (19.3%). Enteroviruses (21/55), Japanese encephalitis virus (17/55), and Streptococcus pneumoniae (7/55) accounted for 45 (81.8%) of all pathogens identified. Of the pathogens detected, 74.5% (41/55) were viruses and 23.6% (13/55) were bacteria. The majority of patients were treated with ceftriaxone empirically. The case fatality rate was 2.5%. CONCLUSIONS Enteroviruses, JEV and S. pneumoniae are the most frequently detected causes of CNS infection in hospitalised Cambodian children.
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Affiliation(s)
- Paul Turner
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Kuong Suy
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Le Van Tan
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, in partnership with the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Pora Sar
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Thyl Miliya
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Nguyen Thi Thu Hong
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, in partnership with the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Vu Thi Ty Hang
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, in partnership with the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Thi Han Ny
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, in partnership with the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Sona Soeng
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Nicholas P. J. Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - H. Rogier van Doorn
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, in partnership with the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Claudia Turner
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Mori D, Khanam W, Sheikh RA, Tabib SMSB, Ikebe E, Hossain MM, Iha H, Ahmed K. Increased serum vascular endothelial growth factor is associated with acute viral encephalitis in Bangladeshi children. Sci Rep 2017; 7:16181. [PMID: 29170534 PMCID: PMC5700941 DOI: 10.1038/s41598-017-16474-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/13/2017] [Indexed: 11/30/2022] Open
Abstract
Encephalitis causes significant global morbidity and mortality. A large number of viruses cause encephalitis, and their geographic and temporal distributions vary. In many encephalitis cases, the virus cannot be detected, even after extensive testing. This is one challenge in management of the encephalitis patient. Since cytokines are pivotal in any form of inflammation and vary according to the nature of the inflammation, we hypothesized cytokine levels would allow us to discriminate between encephalitis caused by viruses and other aetiologies. This pilot study was conducted in a tertiary care hospital in Dhaka, Bangladesh. Viral detection was performed by polymerase chain reaction using patient cerebrospinal fluid. Acute phase reactants and cytokines were detected in patient serum. Of the 29 biomarkers assessed using the Wilcoxon rank-sum test, only vascular endothelial growth factor (VEGF) was significantly higher (P = 0.0015) in viral-positive compared with virus–negative encephalitis patients. The area under the curve (AUC) for VEGF was 0.82 (95% confidence interval: 0.66–0.98). Serum VEGF may discriminate between virus-positive and virus-negative encephalitis. Further study will be needed to confirm these findings.
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Affiliation(s)
- Daisuke Mori
- Department of Pathobiology and Medical Diagnostics, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, 88400, Malaysia
| | - Wahida Khanam
- Department of Paediatrics, Institute of Child and Mother Health, Dhaka, 1362, Bangladesh
| | - Rahamot Ali Sheikh
- Department of Paediatrics, Institute of Child and Mother Health, Dhaka, 1362, Bangladesh
| | - S M Shahnawaz Bin Tabib
- Department of Pathobiology and Medical Diagnostics, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, 88400, Malaysia
| | - Emi Ikebe
- Department of Microbiology, Faculty of Medicine, Oita University, Yufu, 879-5593, Oita, Japan
| | | | - Hidekatsu Iha
- Department of Microbiology, Faculty of Medicine, Oita University, Yufu, 879-5593, Oita, Japan
| | - Kamruddin Ahmed
- Department of Pathobiology and Medical Diagnostics, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, 88400, Malaysia.
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Influenza-associated Encephalitis/Encephalopathy Identified by the Australian Childhood Encephalitis Study 2013-2015. Pediatr Infect Dis J 2017; 36:1021-1026. [PMID: 28654561 DOI: 10.1097/inf.0000000000001650] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Influenza-associated encephalitis/encephalopathy (IAE) is an important cause of acute encephalitis syndrome in children. IAE includes a series of clinicoradiologic syndromes or acute encephalopathy syndromes that have been infrequently reported outside East Asia. We aimed to describe cases of IAE identified by the Australian Childhood Encephalitis study. METHODS Children ≤ 14 years of age with suspected encephalitis were prospectively identified in 5 hospitals in Australia. Demographic, clinical, laboratory, imaging, and outcome at discharge data were reviewed by an expert panel and cases were categorized by using predetermined case definitions. We extracted cases associated with laboratory identification of influenza virus for this analysis; among these cases, specific IAE syndromes were identified where clinical and radiologic features were consistent with descriptions in the published literature. RESULTS We identified 13 cases of IAE during 3 southern hemisphere influenza seasons at 5 tertiary children's hospitals in Australia; 8 children with specific acute encephalopathy syndromes including: acute necrotizing encephalopathy, acute encephalopathy with biphasic seizures and late diffusion restriction, mild encephalopathy with reversible splenial lesion, and hemiconvulsion-hemiplegia syndrome. Use of influenza-specific antiviral therapy and prior influenza vaccination were infrequent. In contrast, death or significant neurologic morbidity occurred in 7 of the 13 children (54%). CONCLUSIONS The conditions comprising IAE are heterogeneous with varied clinical features, magnetic resonance imaging changes, and outcomes. Overall, outcome of IAE is poor emphasizing the need for optimized prevention, early recognition, and empiric management.
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Upreti SR, Lindsey NP, Bohara R, Choudhary GR, Shakya S, Gautam M, Giri JN, Fischer M, Hills SL. Updated estimation of the impact of a Japanese encephalitis immunization program with live, attenuated SA 14-14-2 vaccine in Nepal. PLoS Negl Trop Dis 2017; 11:e0005866. [PMID: 28934197 PMCID: PMC5608168 DOI: 10.1371/journal.pntd.0005866] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/10/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Japanese encephalitis (JE) is a mosquito-borne disease that is associated with considerable morbidity and mortality in many Asian countries. The objective of this study was to describe the impact of the JE immunization program using SA 14-14-2 JE vaccine implemented in Nepal during 2006 through 2011. A previous assessment after the initial program implementation phase described a significantly lower post-campaign JE incidence compared to expected incidence; however, the previous evaluation had limited post-campaign data for some districts. METHODOLOGY/PRINCIPAL FINDINGS JE and acute encephalitis syndrome (AES) data gathered through Nepal's routine surveillance system from 2004 through 2014 were analyzed to assess the impact of the JE immunization program implemented in 31 districts. Expected incidence rates were determined by calculating the incidence of cases per 100,000 person-years in each district before the vaccination campaigns. This rate was applied to the relevant population after the vaccination campaigns, which provided the expected number of cases had the campaign not occurred. The observed incidence rate was the number of reported cases per 100,000 person-years post-campaign. Expected and observed JE and AES cases and incidence rates were compared. The post-campaign JE incidence rate of 0.7 cases per 100,000 was 78% (95% CI 76%-79%) lower than expected had no campaign occurred and an estimated 3,011 (95% CI 2,941-3,057) JE cases were prevented. The post-vaccination AES incidence of 5.5 cases per 100,000 was 59% (58%-60%) lower than the expected and an estimated 9,497 (95% CI 9,268-9,584) AES cases were prevented. CONCLUSIONS/SIGNIFICANCE This analysis strengthens previous findings of the substantial impact of Nepal's JE immunization program using SA 14-14-2 JE vaccine.
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Affiliation(s)
- Shyam Raj Upreti
- Child Health Division, Ministry of Health and Population, Kathmandu, Nepal
| | - Nicole P. Lindsey
- Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, CO, United States of America
| | - Rajendra Bohara
- Programme for Immunization Preventable Diseases, World Health Organization, Kathmandu, Nepal
| | - Ganga Ram Choudhary
- Programme for Immunization Preventable Diseases, World Health Organization, Kathmandu, Nepal
| | - Sushil Shakya
- Programme for Immunization Preventable Diseases, World Health Organization, Kathmandu, Nepal
| | - Mukunda Gautam
- Child Health Division, Ministry of Health and Population, Kathmandu, Nepal
| | - Jagat Narain Giri
- Programme for Immunization Preventable Diseases, World Health Organization, Kathmandu, Nepal
| | - Marc Fischer
- Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, CO, United States of America
| | - Susan L. Hills
- Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, CO, United States of America
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Ngwe Tun MM, V Muthugala R, Thi Thu Thuy N, Hoai Linh Ly P, Thi Hien Thu L, Thi Dinh D, Viet Hoang N, Thi Quynh Mai L, Moi ML, C Buerano C, Morita K, Hasebe F. Dengue Associated Acute Encephalitis Syndrome Cases in Son La Province, Vietnam in 2014. Jpn J Infect Dis 2017; 70:357-361. [PMID: 27795473 DOI: 10.7883/yoken.jjid.2016.246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute encephalitis syndrome (AES) is associated with high morbidity and mortality, and affects both children and adults. The main etiologic agent is Japanese encephalitis virus (JEV); however, there are also reports of Dengue virus (DENV) encephalitis. The objectives of this study were to determine the proportion of patients with encephalitis due to JEV during the 2014 outbreak in Son La Province in Vietnam and to explore the association of DENV in non-JEV viral encephalitis cases. Of 90 patients, 6 (6.7%) were positive for anti-JEV immunoglobulin M (IgM), 5 (5.6%) were positive for anti-DENV IgM, 30 (33.3%) were positive for both anti-JEV and anti-DENV IgM, and 56 (62.2%) were positive for flavivirus immunoglobulin G (IgG). In 5 patients with AES, who had positive anti-DENV IgM results in at least one of the paired serum samples, DENV was confirmed by neutralization testing. The incidence of JEV infection was high. There is still a need to maintain and strengthen the national JEV immunization program. This noticeable occurrence of DENV infection was not reported in Son La Province in 2013-2014. Our data suggested that in addition to JEV, DENV was also a causative agent of AES in 2014 in Son La Province, and this finding also confirmed the local occurrence of DENV infection.
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Affiliation(s)
- Mya Myat Ngwe Tun
- Department of Virology, Institute of Tropical Medicine, Nagasaki University
| | | | | | | | - Le Thi Hien Thu
- Department of Virology, National Institute of Hygiene and Epidemiology
| | - Dang Thi Dinh
- Department of Virology, National Institute of Hygiene and Epidemiology
| | - Nguyen Viet Hoang
- Department of Virology, National Institute of Hygiene and Epidemiology
| | - Le Thi Quynh Mai
- Department of Virology, National Institute of Hygiene and Epidemiology
| | - Meng Ling Moi
- Department of Virology, Institute of Tropical Medicine, Nagasaki University
| | - Corazon C Buerano
- Department of Virology, Institute of Tropical Medicine, Nagasaki University
| | - Kouichi Morita
- Department of Virology, Institute of Tropical Medicine, Nagasaki University
| | - Futoshi Hasebe
- Department of Virology, Institute of Tropical Medicine, Nagasaki University.,Center for International Collaborative Research, Nagasaki University
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Ai J, Xie Z, Liu G, Chen Z, Yang Y, Li Y, Chen J, Zheng G, Shen K. Etiology and prognosis of acute viral encephalitis and meningitis in Chinese children: a multicentre prospective study. BMC Infect Dis 2017; 17:494. [PMID: 28705180 PMCID: PMC5513334 DOI: 10.1186/s12879-017-2572-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 06/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In China, there were few studies about the pathogens of acute viral encephalitis and meningitis in children in recent years. The aims of this study were to characterize the etiology and prognosis of acute viral encephalitis and meningitis in Chinese children. METHODS This was a multicentre prospective study. Two hundred and sixty one viral encephalitis patients and 285 viral meningitis patients were enrolled. The mean age of viral encephalitis and meningitis were 5.88 ± 3.60 years and 6.39 ± 3.57 years, respectively. Real-time reverse transcription PCR and multiplex PCR were used to detect human enteroviruses and herpes viruses in cerebrospinal fluid (CSF) of patients with encephalitis or meningitis. The enzyme-linked immune absorbent assay (ELISA) was used for detecting IgM antibody against Japanese encephalitis virus (JEV) in CSF and against mumps virus, tick-borne encephalitis virus (TBEV), dengue virus and rubella virus in acute serum. The clinical and outcome data were collected during patients' hospitalization. RESULTS The etiology of viral encephalitis was confirmed in 52.5% patients. The primary pathogen was human enteroviruses (27.7%) in viral encephalitis. The incidence of sequelae and the fatality rate of viral encephalitis with confirmed etiology were 7.5% and 0.8%, respectively. The etiology of viral meningitis was identified in 42.8% cases. The leading pathogen was also human enteroviruses (37.7%) in viral meningitis. The prognosis of viral meningitis was favorable with only 0.7% patients had neurological sequelae. CONCLUSIONS Human enteroviruses were the leading cause both in acute viral encephalitis and viral meningitis in children. The incidence of sequelae and fatality rate of viral encephalitis with confirmed etiology were 7.5% and 0.8%, respectively. The prognosis of viral meningitis was favorable compared to viral encephalitis.
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Affiliation(s)
- Junhong Ai
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Virology Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Zhengde Xie
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Virology Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
| | - Gang Liu
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Virology Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Zongbo Chen
- The Affiliated Hospital of Qingdao University, Shandong province, Qingdao, China
| | - Yong Yang
- The First Hospital of Yulin, Shanxi province, Yulin, China
| | - Yuning Li
- The First Hospital of Lanzhou University, Gansu province, Lanzhou, China
| | - Jing Chen
- Nanjing Children's Hospital, Jiangsu province, Nanjing, China
| | - Guo Zheng
- Nanjing Children's Hospital, Jiangsu province, Nanjing, China
| | - Kunling Shen
- National Clinical Research Center for Respiratory Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, Respiratory Department, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
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Akhuemokhan OC, Ewah-Odiase RO, Akpede N, Ehimuan J, Adomeh DI, Odia I, Olomu SC, Pahlmann M, Becker-Ziaja B, Happi CT, Asogun DA, Okogbenin SA, Okokhere PO, Dawodu OS, Omoike IU, Sabeti PC, Günther S, Akpede GO. Prevalence of Lassa Virus Disease (LVD) in Nigerian children with fever or fever and convulsions in an endemic area. PLoS Negl Trop Dis 2017; 11:e0005711. [PMID: 28671959 PMCID: PMC5510890 DOI: 10.1371/journal.pntd.0005711] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 07/14/2017] [Accepted: 06/13/2017] [Indexed: 12/18/2022] Open
Abstract
Background Convulsions with fever in children are a common neurologic emergency in the tropics, and determining the contribution of endemic viral infections can be challenging. In particular, there is a dearth of data on the prevalence and clinical differentiation of Lassa virus disease (LVD) in febrile children in endemic areas of Nigeria, which has multiple lineages of the virus. The aim of this study was to determine the prevalence and presentation of LVD in febrile children with and without convulsions. Methodology/Principal findings This was a prospective study of consecutive febrile children aged ≥1 month– 15 years admitted to the Children’s Emergency Room of Irrua Specialist Teaching Hospital over a period of 1 year. Febrile children with convulsions (Cases) were compared with those without convulsions (Controls). LVD was defined by the presence of a positive Lassa virus RT-PCR test. Rates were compared between groups using χ2 or Fisher’s exact tests and p <0.05 taken as significant. 373 (40.9%) of 913 admissions had fever. Of these, 108/373 (29%) presented with convulsions. The overall prevalence of LVD was 13/373 (3.5%; 95% CI = 1.9%, 5.7%) in febrile admissions, 3/108 (2.8%) in Cases and 10/265 (3.8%) in Controls [(Odds Ratio (95% Confidence Interval) (OR (95% CI)) of LVD in Cases versus Controls = 0.73 (0.2, 2.7)]. Only vomiting (OR (95% CI) = 0.09 (0.01, 0.70)) and bleeding (OR (95% CI) = 39.56 (8.52, 183.7)) were significantly associated with an increased prevalence of LVD. Conclusions/Significance LVD is an important cause of fever, including undifferentiated fever in children in endemic areas, but it is not significantly associated with convulsions associated with fever. Its prevalence, and lack of clinical differentiation on presentation, underscores the importance of a high index of suspicion in diagnosis. Screening of febrile children with undifferentiated fever in endemic areas for LVD could be an important medical and public health control measure. There has, perhaps, been undue focus on malaria as a cause of childhood fever and convulsions, often with delayed/missed diagnosis of other serious prevalent infections, and correspondingly very little published data on the contribution of Lassa virus disease (LVD) in endemic areas. There is also very little published data on the contribution of LVD to childhood morbidity and mortality in Nigeria, a large LVD-endemic country that has in circulation 3 of the 4 currently known lineages of the Lassa virus. This study was carried out to address these gaps. The results should also be of relevance in the formulation of policies for the treatment and control of viral haemorrhagic fevers. The prevalence of LVD was 5.4% among children with clinically undifferentiated fever (n = 243); 3.9% among those with convulsions associated with fever (n = 77) and 6.0% among those with fever but no convulsions (n = 166). The results underscore the importance of LVD as a cause of acute undifferentiated fever. The results also underscore the need of diagnostic testing for LVD in children with acute undifferentiated fever in endemic areas in order to facilitate control, including the prevention of nosocomial transmission.
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Affiliation(s)
- Odigie C. Akhuemokhan
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | | | - Nosa Akpede
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Jacqueline Ehimuan
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Donatus I. Adomeh
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Ikpomwonsa Odia
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Sylvia C. Olomu
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Meike Pahlmann
- Bernhard-Nocht-Institute for Tropical Medicine, WHO Collaborating Centre for Arboviruses and Hemorrhagic Fever Reference and Research, Department of Virology, Bernhard-Nocht-Str. 74, Hamburg, Germany
| | - Beate Becker-Ziaja
- Bernhard-Nocht-Institute for Tropical Medicine, WHO Collaborating Centre for Arboviruses and Hemorrhagic Fever Reference and Research, Department of Virology, Bernhard-Nocht-Str. 74, Hamburg, Germany
| | - Christian T. Happi
- Malaria Research Laboratory, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Danny A. Asogun
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Sylvanus A. Okogbenin
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Peter O. Okokhere
- Department of Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Osagie S. Dawodu
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Irekpono U. Omoike
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Pardis C. Sabeti
- Department of Organismic Biology, Broad Institute, Harvard University, Cambridge, Massachusetts, United States of America
| | - Stephan Günther
- Bernhard-Nocht-Institute for Tropical Medicine, WHO Collaborating Centre for Arboviruses and Hemorrhagic Fever Reference and Research, Department of Virology, Bernhard-Nocht-Str. 74, Hamburg, Germany
| | - George O. Akpede
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, Ambrose Alli University, Ekpoma, Edo State, Nigeria
- * E-mail:
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Aetiology of acute meningoencephalitis in Cambodian children, 2010-2013. Emerg Microbes Infect 2017; 6:e35. [PMID: 28536430 PMCID: PMC5520480 DOI: 10.1038/emi.2017.15] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/07/2017] [Accepted: 02/13/2017] [Indexed: 01/09/2023]
Abstract
Acute meningoencephalitis (AME) is associated with considerable morbidity and mortality in children in developing countries. Clinical specimens were collected from children presenting with AME at two Cambodian paediatric hospitals to determine the major aetiologies associated with AME in the country. Cerebrospinal fluid (CSF) and blood samples were screened by molecular and cell culture methods for a range of pathogens previously associated with AME in the region. CSF and serum (acute and convalescent) were screened for antibodies to arboviruses such as Japanese encephalitis virus (JEV), dengue virus (DENV), and chikungunya virus (CHIKV). From July 2010 through December 2013, 1160 children (one month to 15 years of age) presenting with AME to two major paediatric hospitals were enroled into the study. Pathogens associated with AME were identified using molecular diagnostics, cell culture and serology. According to a diagnostic algorithm, a confirmed or highly probable aetiologic agent was detected in 35.0% (n=406) of AME cases, with a further 9.2% (total: 44.2%, n=513) aetiologies defined as suspected. JEV (24.4%, n=283) was the most commonly identified pathogen followed by Orientia tsutsugamushi (4.7%, n=55), DENV (4.6%, n=53), enteroviruses (3.5%, n=41), CHIKV (2.0%, n=23) and Streptococcus pneumoniae (1.6%, n=19). The majority of aetiologies identified for paediatric AME in Cambodia were vaccine preventable and/or treatable with appropriate antimicrobials.
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Crabol Y, Pean P, Mey C, Duong V, Richner B, Laurent D, Santy K, Sothy H, Dussart P, Tarantola A, Buchy P, Horwood PF. A prospective, comparative study of severe neurological and uncomplicated hand, foot and mouth forms of paediatric enterovirus 71 infections. Int J Infect Dis 2017; 59:69-76. [PMID: 28438677 DOI: 10.1016/j.ijid.2017.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/06/2017] [Accepted: 04/03/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES In this study, we document the clinical characteristics and investigated risk factors for uncomplicated and severe forms of EV-A71 disease in Cambodian children. METHODS From March to July 2014 inclusive, all patients with suspicion of EV-A71 infection presenting to Kantha Bopha Hospitals in Phnom Penh and Siem Reap and confirmed by the Virology Unit at the Institut Pasteur du Cambodge were prospectively enrolled in this study. Throat swabs, rectal swabs and serum samples were collected from all consecutive patients with suspected EV-A71 infection. In addition, CSF was also collected from patients with suspected EV-A71 associated encephalitis. A total of 122 patients (29 with uncomplicated disease and 93 with severe disease) with confirmed EV-A71 infection with all available demographic and clinical data for clinical classification and further analysis were included in the study. RESULTS In this prospective EV-A71 study in Cambodia, we confirmed the previously reported association of male gender and absence of mouth or skin lesions with severe disease. We also highlighted the strong association of neutrophils in blood, but also in CSF in patients with pulmonary oedema. More importantly, we identified new putative nutrition-related risk factors for severe disease. CONCLUSIONS EV-A71 is an important cause of encephalitis in the Asia-Pacific region. Further studies to determine the risk factors associated with severe EV-A71 disease are needed.
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Affiliation(s)
- Yoann Crabol
- Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Polidy Pean
- Immunology Platform, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Channa Mey
- Virology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Veasna Duong
- Virology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | | | | | - Ky Santy
- Kantha Bopha Hospital, Phnom Penh, Cambodia
| | - Heng Sothy
- Kantha Bopha Hospital, Phnom Penh, Cambodia
| | - Philippe Dussart
- Virology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Arnaud Tarantola
- Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Philippe Buchy
- Virology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia; GlaxoSmithKline Vaccines Asia-Pacific, Singapore.
| | - Paul F Horwood
- Virology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia.
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de Oliveira DB, Candiani TM, Franco-Luiz APM, Almeida GMF, Abrahão JS, Rios M, Coimbra RS, Kroon EG. Etiological agents of viral meningitis in children from a dengue-endemic area, Southeast region of Brazil. J Neurol Sci 2017; 375:390-394. [PMID: 28320174 DOI: 10.1016/j.jns.2017.02.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 11/19/2022]
Abstract
Meningitis is a disease with a global distribution that constitutes a worldwide burden, with viruses as the primary etiologic agents. The range of viral meningitis severity depends mainly on age, immune status and etiological agent. The aim of this work was to investigate the suspected cases of viral meningitis using molecular techniques to confirm the viral infection. The diagnosed virus was correlated with clinical findings and cytochemical parameters in cerebrospinal liquid (CSF) of patients. CSF of 70 children with the presumptive diagnosis of viral meningitis was analyzed by real time PCR (qPCR). Viruses were identified by qPCR in 44 CSF samples (62.9%). Among them, 31 were identified as Enterovirus (ENTV) (70.4%), six as Human herpes virus 3 (HHV-3) (13.6%), five as Dengue virus (DENV) (11.7%), one as Human herpes virus 1-2 (2.3%) and one as Human herpes virus 5 (2.3%). Patients in the HHV-positive groups had increased percentage of polymorphonuclear neutrophils (PMN) (mean of 81%) while the groups of patients with DENV and ENTV had a mean of 30.9%. This study contributes to the knowledge of the epidemiological distribution of viral agents in CNS infections in children. In addition, it raises the relevance of DENV as an agent of CNS infection, and reinforces the importance for molecular in the cases of CNV infection.
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Affiliation(s)
- Danilo B de Oliveira
- Departamento de Microbiologia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil; Faculdade de Medicina de Diamantina, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina 39100-000, Brazil
| | - Talitah M Candiani
- Hospital Infantil João Paulo II, FHEMIG, Belo Horizonte 30130-110, Brazil
| | - Ana Paula M Franco-Luiz
- Departamento de Microbiologia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Gabriel M F Almeida
- Departamento de Microbiologia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Jônatas S Abrahão
- Departamento de Microbiologia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Maria Rios
- Center for Biologics Research and Review, Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Roney S Coimbra
- Neurogenômica, Centro de Pesquisas René Rachou, FIOCRUZ, Belo Horizonte 30190-002, Brazil
| | - Erna G Kroon
- Departamento de Microbiologia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil.
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Lee HS, Nguyen-Viet H, Lee M, Duc PP, Grace D. Seasonality of Viral Encephalitis and Associated Environmental Risk Factors in Son La and Thai Binh Provinces in Vietnam from 2004 to 2013. Am J Trop Med Hyg 2016; 96:110-117. [PMID: 27799646 DOI: 10.4269/ajtmh.16-0471] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/22/2016] [Indexed: 12/15/2022] Open
Abstract
In Vietnam, Japanese encephalitis virus accounts for 12-71% of viral encephalitis (VE) cases followed by enteroviruses and dengue virus among identified pathogens. This study is the first attempt to evaluate the seasonality of VE and associated environmental risk factors in two provinces from 2004 to 2013 using a seasonal trend-decomposition procedure based on loess regression and negative binomial regression models. We found seasonality with a peak of VE in August and June in Son La and Thai Binh, respectively. In Son La, the model showed that for every 1°C increase in average monthly temperature, there was a 4.0% increase in monthly VE incidence. There was a gradual decline in incidence rates as the relative humidity rose to its mean value (80%) and a dramatic rise in incidence rate as the relative humidity rose past 80%. Another model found that a 100 mm rise in precipitation in the preceding and same months corresponded to an increase in VE incidence of 23% and 21%, respectively. In Thai Binh, our model showed that a 1°C increase in temperature corresponded with a 9% increase in VE incidence. Another model found that VE incidence increased as monthly precipitation rose to its mean value of 130 mm but declined gradually as precipitation levels rose beyond that. The last model showed that a monthly increase in duration of sunshine of 1 hour corresponded to a 0.6% increase in VE incidence. The findings may assist clinicians by improving the evidence for diagnosis.
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Affiliation(s)
- Hu Suk Lee
- International Livestock Research Institute, Hanoi, Vietnam.
| | | | - Mihye Lee
- Medical Microbiology Department, The Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Phuc Pham Duc
- Center for Public Health and Ecosystem Research, Hanoi School of Public Health, Hanoi, Vietnam
| | - Delia Grace
- International Livestock Research Institute, Nairobi, Kenya
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Maude RR, Ghose A, Samad R, de Jong HK, Fukushima M, Wijedoru L, Hassan MU, Hossain MA, Karim MR, Sayeed AA, van den Ende S, Pal S, Zahed ASM, Rahman W, Karnain R, Islam R, Tran DTN, Ha TT, Pham AH, Campbell JI, van Doorn HR, Maude RJ, van der Poll T, Wiersinga WJ, Day NPJ, Baker S, Dondorp AM, Parry CM, Faiz MA. A prospective study of the importance of enteric fever as a cause of non-malarial febrile illness in patients admitted to Chittagong Medical College Hospital, Bangladesh. BMC Infect Dis 2016; 16:567. [PMID: 27737634 PMCID: PMC5064917 DOI: 10.1186/s12879-016-1886-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 10/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fever is a common cause of hospital admission in Bangladesh but causative agents, other than malaria, are not routinely investigated. Enteric fever is thought to be common. METHODS Adults and children admitted to Chittagong Medical College Hospital with a temperature of ≥38.0 °C were investigated using a blood smear for malaria, a blood culture, real-time PCR to detect Salmonella Typhi, S. Paratyphi A and other pathogens in blood and CSF and an NS1 antigen dengue ELISA. RESULTS We enrolled 300 febrile patients with a negative malaria smear between January and June 2012: 156 children (aged ≤15 years) and 144 adults with a median (interquartile range) age of 13 (5-31) years and median (IQR) illness duration before admission of five (2-8) days. Clinical enteric fever was diagnosed in 52 patients (17.3 %), lower respiratory tract infection in 48 (16.0 %), non-specific febrile illness in 48 (16.0 %), a CNS infection in 37 patients (12.3 %), urinary sepsis in 23 patients (7.7 %), an upper respiratory tract infection in 21 patients (7.0 %), and diarrhea or dysentery in 21 patients (7.0 %). Malaria was still suspected in seven patients despite a negative microscopy test. S. Typhi was detected in blood by culture or PCR in 34 (11.3 %) of patients. Of note Rickettsia typhi and Orientia tsutsugamushi were detected by PCR in two and one patient respectively. Twenty-nine (9 %) patients died during their hospital admission (15/160 (9.4 %) of children and 14/144 (9.7 %) adults). Two of 52 (3.8 %) patients with enteric fever, 5/48 (10.4 %) patients with lower respiratory tract infections, and 12/37 (32.4 %) patients with CNS infection died. CONCLUSION Enteric fever was confirmed in 11.3 % of patients admitted to this hospital in Bangladesh with non-malaria fever. Lower respiratory tract and CNS infections were also common. CNS infections in this location merit more detailed study due to the high mortality.
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Affiliation(s)
- Rapeephan R Maude
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Rasheda Samad
- Chittagong Medical College Hospital, Chittagong, Bangladesh
| | - Hanna K de Jong
- Department of Internal Medicine, Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA), and Center for Experimental Molecular Medicine (CEMM), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Masako Fukushima
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lalith Wijedoru
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | | | | | | | - Stannie van den Ende
- Department of Internal Medicine, Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA), and Center for Experimental Molecular Medicine (CEMM), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sujat Pal
- Chittagong Medical College Hospital, Chittagong, Bangladesh
| | - A S M Zahed
- Chittagong Medical College Hospital, Chittagong, Bangladesh
| | - Wahid Rahman
- Chittagong Medical College Hospital, Chittagong, Bangladesh
| | - Rifat Karnain
- Chittagong Medical College Hospital, Chittagong, Bangladesh
| | - Rezina Islam
- Chittagong Medical College Hospital, Chittagong, Bangladesh
| | - Dung Thi Ngoc Tran
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit (OUCRU), Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Tuyen Thanh Ha
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit (OUCRU), Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Anh Hong Pham
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit (OUCRU), Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - James I Campbell
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit (OUCRU), Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| | - H Rogier van Doorn
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit (OUCRU), Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| | - Richard J Maude
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| | - Tom van der Poll
- Department of Internal Medicine, Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA), and Center for Experimental Molecular Medicine (CEMM), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - W Joost Wiersinga
- Department of Internal Medicine, Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA), and Center for Experimental Molecular Medicine (CEMM), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicholas P J Day
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| | - Stephen Baker
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit (OUCRU), Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK.,Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Arjen M Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| | - Christopher M Parry
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. .,Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
| | - Md Abul Faiz
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Malaria Research Group and Dev Care Foundation, Chittagong, Bangladesh
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Misra UK, Kalita J, Mani VE, Chauhan PS, Kumar P. Central nervous system and muscle involvement in dengue patients: A study from a tertiary care center. J Clin Virol 2015; 72:146-51. [DOI: 10.1016/j.jcv.2015.08.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/26/2015] [Accepted: 08/31/2015] [Indexed: 11/26/2022]
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Mallewa M, Vallely P, Faragher B, Banda D, Klapper P, Mukaka M, Khofi H, Pensulo P, Taylor T, Molyneux M, Solomon T. Viral CNS infections in children from a malaria-endemic area of Malawi: a prospective cohort study. LANCET GLOBAL HEALTH 2015; 1:e153-60. [PMID: 24748325 PMCID: PMC3986031 DOI: 10.1016/s2214-109x(13)70060-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Fever with reduced consciousness is an important cause of hospital admission of children in sub-Saharan Africa, with high mortality. Cerebral malaria, diagnosed when acute Plasmodium falciparum infection and coma are recorded with no other apparent reason, is one important cause. We investigated whether viruses could also be an important cause of CNS infection in such patients, and examined the relative contribution of viral pathogens and malaria parasitaemia. Methods We did a prospective cohort study in Blantyre, Malawi. From March 1, 2002, to Aug 31, 2004, we enrolled children aged between 2 months and 15 years who were admitted to hospital with suspected non-bacterial CNS infections. Children with a cerebrospinal fluid (CSF) white cell count of less than 1000 cells per μL and negative bacterial microscopy and culture were deemed to have suspected viral CNS infection. Blood was examined for asexual forms of P falciparum. PCR was done on CSF or on post-mortem brain biopsy specimens to detect 15 viruses known to cause CNS infection. Findings Full outcome data were available for 513 children with suspected viral CNS infection, of whom 94 (18%) died. 163 children (32%) had P falciparum parasitaemia, of whom 34 (21%) died. At least one virus was detected in the CNS in 133 children (26%), of whom 43 (33%) died. 12 different viruses were detected; adenovirus was the most common, affecting 42 children; mumps, human herpes virus 6, rabies, cytomegalovirus, herpes simplex virus 1, and enterovirus were also important. 45 (9%) of the 513 children had both parasitaemia and viral infection, including 27 (35%) of 78 diagnosed clinically with cerebral malaria. Children with dual infection were more likely to have seizures than were those with parasitaemia alone, viral infection only, or neither (p<0·0001). 17 (38%) of the 45 children with dual infection died, compared with 26 (30%) of 88 with viral infection only, 17 (14%) of 118 with parasitaemia only, and 34 (13%) of 262 with neither (p<0·0001). Logistic regression showed children with a viral CNS infection had a significantly higher mortality than did those who did not have a viral CNS infection (p=0·001). Interpretation Viral CNS infections are an important cause of hospital admission and death in children in Malawi, including in children whose coma might be attributed solely to cerebral malaria. Interaction between viral infection and parasitaemia could increase disease severity. Funding Wellcome Trust, US National Institutes of Health, and UK Medical Research Council.
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