Abstract
BackgroundViral central nervous system (CNS) infections are common in countries where malaria is endemic but, due to limited laboratory facilities, few studies have systematically examined the prevalence and clinical consequences of the presence of viruses in cerebrospinal fluid (CSF) from children with suspected CNS infection.MethodsWe performed a prospective study of Papua New Guinean children hospitalized with signs and symptoms of CNS infection. CSF samples from 300 children without proven bacterial/fungal meningitis were analyzed for human herpes viruses (HHV), picornaviruses, influenza, adenoviruses, flaviviruses and bacteria.ResultsFifty-five children (18%) had viral (42), bacterial (20) or both viral and bacterial (7) nucleic acids (NA) identified in their CSF. Human herpes viruses accounted for 91% of all viruses found. The identification of viral or bacterial NA was not associated with any characteristic clinical features. By contrast, malaria was associated with increased identification of viral and bacterial NA and with impaired consciousness, multiple convulsions and age. Malaria was also inversely associated with an adverse outcome. Amongst children with HHV infection, those with HHV-6 and −7 were younger, were more likely have impaired consciousness and had a higher proportion of adverse outcomes than children with CMV. Dengue and enteroviral infections were infrequent. Adenoviral and influenza infections were not identified.ConclusionInfections with HHV-6, HHV-7, dengue and enterovirus have the potential to cause serious CNS disease in young PNG children. However most HHVs in this malaria-endemic setting should be considered to be the result of reactivation from a latent reservoir without clinical sequelae.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0630-0) contains supplementary material, which is available to authorized users.
Highlights
Viral central nervous system (CNS) infections are common in countries where malaria is endemic but, due to limited laboratory facilities, few studies have systematically examined the prevalence and clinical consequences of the presence of viruses in cerebrospinal fluid (CSF) from children with suspected CNS infection
Of 638 children presenting with clinical features suggestive of CNS infection, a lumbar puncture (LP) was performed in 554 (87%)
The present study provides the first comprehensive data relating to the etiology of possible CNS infections in hospitalized children from a malaria-endemic area of PNG
Summary
Viral central nervous system (CNS) infections are common in countries where malaria is endemic but, due to limited laboratory facilities, few studies have systematically examined the prevalence and clinical consequences of the presence of viruses in cerebrospinal fluid (CSF) from children with suspected CNS infection. The diagnosis and management of central nervous system (CNS) infections can be challenging in malaria-endemic tropical countries due to limited laboratory facilities and therapeutic options. Viral pathogens are increasingly identified in patients who present with clinical features of CNS infection in this setting, where they may be i) the principal cause of the illness, ii) an alternative post-mortem diagnosis in patients with an established. Geographic variability in the incidence, severity and outcome of CM may impact on the viruses detected in children presenting with possible CNS infections [6]. Other possible factors that might influence viral CNS infection include local variability in entero-, adeno- or arbovirus incidence [7], local zoonotic reservoirs that may facilitate the emergence of novel viral pathogens [8], as well as the choice of virus-specific primers that are included in diagnostic multiplex PCR tests
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