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Kuchuloria T, Imnadze P, Mamuchishvili N, Chokheli M, Tsertsvadze T, Endeladze M, Mshvidobadze K, Gatserelia L, Makhviladze M, Kanashvili M, Mikautadze T, Nanuashvili A, Kiknavelidze K, Kokaia N, Makharadze M, Clark DV, Bautista CT, Farrell M, Fadeel MA, Maksoud MA, Pimentel G, House B, Hepburn MJ, Rivard RG. Hospital-Based Surveillance for Infectious Etiologies Among Patients with Acute Febrile Illness in Georgia, 2008-2011. Am J Trop Med Hyg 2015; 94:236-42. [PMID: 26438032 DOI: 10.4269/ajtmh.15-0400] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/20/2015] [Indexed: 11/07/2022] Open
Abstract
Information on the infectious causes of undifferentiated acute febrile illness (AFI) in Georgia is essential for effective treatment and prevention. In May 2008, a hospital-based AFI surveillance was initiated at six hospitals in Georgia. Patients aged ≥ 4 years with fever ≥ 38°C for ≥ 48 hours were eligible for surveillance. Blood culture and serologic testing were conducted for Leptospira spp., Brucella spp., West Nile virus (WNV), Crimean-Congo hemorrhagic fever virus, Coxiella burnetii, tick-borne encephalitis virus (TBEV), hantavirus, Salmonella enterica serovar Typhi (S. Typhi), and Rickettsia typhi. Of 537 subjects enrolled, 70% were outpatients, 54% were males, and the mean age was 37 years. Patients reported having fatigue (89%), rigors (87%), sweating (83%), pain in joints (49%), and sleep disturbances (42%). Thirty-nine (7%) patients were seropositive for R. typhi, 37 (7%) for Brucella spp., 36 (7%) for TBEV, 12 (2%) for Leptospira spp., 10 (2%) for C. burnetii, and three (0.6%) for S. Typhi. None of the febrile patients tested positive for WNV antibodies. Of the patients, 73% were negative for all pathogens. Our results indicate that most of the targeted pathogens are present in Georgia, and highlight the importance of enhancing laboratory capacity for these infectious diseases.
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Affiliation(s)
- Tinatin Kuchuloria
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Paata Imnadze
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Nana Mamuchishvili
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Maiko Chokheli
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Tengiz Tsertsvadze
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Marina Endeladze
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Ketevan Mshvidobadze
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Lana Gatserelia
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Manana Makhviladze
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Marine Kanashvili
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Teona Mikautadze
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Alexander Nanuashvili
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Khatuni Kiknavelidze
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Nora Kokaia
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Manana Makharadze
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Danielle V Clark
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Christian T Bautista
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Margaret Farrell
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Moustafa Abdel Fadeel
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Mohamed Abdel Maksoud
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Guillermo Pimentel
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Brent House
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Matthew J Hepburn
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | - Robert G Rivard
- Javakhishvili Tbilisi State University, Tbilisi, Georgia; United States Army Medical Research Unit-Georgia, Tbilisi, Georgia; National Center for Disease Control and Public Health, Tbilisi, Georgia; Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia; V. Bochorishvili Sepsis Center, Tbilisi, Georgia; Sachkhere Hospital, Sachkhere, Georgia; S. Virsaladze Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia; Walter Reed Army Institute of Research, Silver Spring, Maryland; Global Disease Detection and Response Program, United States Naval Medical Research Unit No. 3, Cairo, Egypt; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
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5
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Akhvlediani T, Bautista CT, Shakarishvili R, Tsertsvadze T, Imnadze P, Tatishvili N, Davitashvili T, Samkharadze T, Chlikadze R, Dvali N, Dzigua L, Karchava M, Gatserelia L, Macharashvili N, Kvirkvelia N, Habashy EE, Farrell M, Rowlinson E, Sejvar J, Hepburn M, Pimentel G, Dueger E, House B, Rivard R. Etiologic agents of central nervous system infections among febrile hospitalized patients in the country of Georgia. PLoS One 2014; 9:e111393. [PMID: 25369023 PMCID: PMC4219716 DOI: 10.1371/journal.pone.0111393] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/24/2014] [Indexed: 11/29/2022] Open
Abstract
Objectives There is a large spectrum of viral, bacterial, fungal, and prion pathogens that cause central nervous system (CNS) infections. As such, identification of the etiological agent requires multiple laboratory tests and accurate diagnosis requires clinical and epidemiological information. This hospital-based study aimed to determine the main causes of acute meningitis and encephalitis and enhance laboratory capacity for CNS infection diagnosis. Methods Children and adults patients clinically diagnosed with meningitis or encephalitis were enrolled at four reference health centers. Cerebrospinal fluid (CSF) was collected for bacterial culture, and in-house and multiplex RT-PCR testing was conducted for herpes simplex virus (HSV) types 1 and 2, mumps virus, enterovirus, varicella zoster virus (VZV), Streptococcus pneumoniae, HiB and Neisseria meningitidis. Results Out of 140 enrolled patients, the mean age was 23.9 years, and 58% were children. Bacterial or viral etiologies were determined in 51% of patients. Five Streptococcus pneumoniae cultures were isolated from CSF. Based on in-house PCR analysis, 25 patients were positive for S. pneumoniae, 6 for N. meningitidis, and 1 for H. influenzae. Viral multiplex PCR identified infections with enterovirus (n = 26), VZV (n = 4), and HSV-1 (n = 2). No patient was positive for mumps or HSV-2. Conclusions Study findings indicate that S. pneumoniae and enteroviruses are the main etiologies in this patient cohort. The utility of molecular diagnostics for pathogen identification combined with the knowledge provided by the investigation may improve health outcomes of CNS infection cases in Georgia.
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Affiliation(s)
- Tamar Akhvlediani
- I. Javakhishvili Tbilisi State University, Department of Neurology and Neurosurgery, Tbilisi, Georgia
- US Army Medical Research Unit-Georgia (USAMRU-G), Tbilisi, Georgia
- * E-mail:
| | - Christian T. Bautista
- Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Roman Shakarishvili
- P. Sarajishvili Institute of Clinical Neurology and Neurosurgery, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia
| | - Paata Imnadze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Nana Tatishvili
- Neurology Department of the Iashvili Children's Hospital, Tbilisi, Georgia
| | - Tamar Davitashvili
- Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia
| | - Tamar Samkharadze
- Neurology Department of the Iashvili Children's Hospital, Tbilisi, Georgia
| | - Rusudan Chlikadze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Natia Dvali
- Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia
| | - Lela Dzigua
- Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia
| | - Mariam Karchava
- Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia
| | - Lana Gatserelia
- Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia
| | - Nino Macharashvili
- Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia
| | - Nana Kvirkvelia
- P. Sarajishvili Institute of Clinical Neurology and Neurosurgery, Tbilisi, Georgia
| | - Engy Emil Habashy
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Margaret Farrell
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Emily Rowlinson
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
| | - James Sejvar
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Matthew Hepburn
- US Army Medical Research Institute of Infectious Diseases, Frederick, Maryland, United States of America
| | - Guillermo Pimentel
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Erica Dueger
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Brent House
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Robert Rivard
- US Army Medical Research Institute of Infectious Diseases, Frederick, Maryland, United States of America
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