Acute Central Nervous System Infections Research Articles

Non-Respiratory and Non-Diarrheal Causes of Acute Febrile Illnesses in Children Requiring Hospitalization in a Tertiary Care Hospital in North India: A Prospective Study.

Acute febrile illnesses (AFIs) in children from the developing world can have varying etiologies. Awareness of local epidemiology helps in prioritizing investigations and empiric treatment. This prospective study was carried out in a tertiary care center in North India, aiming to determine the burden, etiology, and outcome of AFI other than pneumonia and diarrhea in hospitalized children. A total of 613 consecutive children aged 3 months to 12 years with febrile illness of < 7 days during four selected months of 2014 representing different seasons were screened for eligibility. Those with acute respiratory diseases (N = 175, 28.5%) and diarrheal illness (N = 46, 7.5%) were excluded and 217 children were enrolled. Mean (standard deviation) age was 4.8 (3.4) years. Nearly half (N = 91, 41.9%) presented in post-monsoon season. Diagnosis could be established in 187 (86.2%) children. Acute central nervous system infections were the most common (N = 54, 24.8%). Among specific infections, scrub typhus was the most frequent (N = 23, 10.5%) followed by malaria (N = 14, 6.4%), typhoid (N = 14, 6.5%), and viral hepatitis (N = 13, 6.0%). Blood culture had a low (6.5%) yield; Salmonella typhi (N = 6) and Staphylococcus aureus (N = 5) were the common isolates. Serological tests were helpful in 50 (23%) cases. In multivariate analysis, hepatomegaly and/or splenomegaly independently predicted scrub typhus. Mortality rate was 10.1%. We conclude that AFI other than pneumonia and diarrhea are a significant burden and follow a seasonal trend. Scrub typhus has emerged as an important etiology of childhood AFIs in northern India. Periodic review of regional epidemiology will help in understanding the changing pattern of infectious diseases.

Syndromic categorization of acute central nervous system infections may help clinicians rationalize use of neuroimaging (P5.341)

Syndromic categorization of acute central nervous system infections may help clinicians rationalize use of neuroimaging (P5.341)

Nonconvulsive status epilepticus after cessation of convulsive status epilepticus in pediatric intensive care unit patients

Little is known about pediatric patients suffering from nonconvulsive status epilepticus (NCSE) after convulsive status epilepticus (CSE) cessation. The aim of this study was to identify in pediatric patients the clinical characteristics of NCSE after CSE cessation and the factors that contribute to patient outcomes. Data from clinical features, electroencephalography (EEG) characteristics, neuroimaging findings, treatments, and prognosis were systematically summarized, and the associations between clinical characteristics and prognosis were quantified. Thirty-eight children aged 51days–14years, 2months were identified in the Chongqing Medical University pediatric intensive care unit as having experienced NCSE after CSE cessation between October 1, 2014 and April 1, 2017. All patients were comatose, 15 of whom presented subtle motor signs. The most common underlying etiology was acute central nervous system (CNS) infection. Electroencephalography (EEG) data showed that, during the NCSE period, all patients had several discrete episodes (lasting from 30s to 6h long), and the most common duration was 1–5min. The ictal onset locations were classified as focal (16 patients, 42.1%), multiregional independent (10 patients, 26.3%), and generalized (12 patients, 31.6%). Wave morphologies varied during the ictal and interictal periods. Neuroimaging detected signal abnormalities in the cerebral cortex or subcortex of 33 patients with NCSE (87%), which were classified as either multifocal and consistent with extensive cortical edema (21 patients, 55.3%) or focal (12 patients, 31.6%). Twelve patients were on continuous intravenous phenobarbital, and 31 were on continuous infusion of either midazolam (27 patients) or propofol (4 patients). At least one other antiepileptic drug was prescribed for 32 patients. Three patients were on mild hypothermia therapy. The duration of NCSE lasted <24h for 20 patients and >24h for 18 patients. The mortality rate was 21.1%, and half of the surviving patients had severe neurological morbidity. Our results indicated that EEG monitoring after treatment of CSE was essential to the recognition of persistent seizures. The clinical features, EEG characteristics, and neuroimaging findings varied during the NCSE period. The morbidity is high in pediatric patients who had NCSE after CSE. Convulsive status epilepticus (CSE) duration and neuroimaging results may be related to the prognosis.

Cerebrospinal fluid C-reactive protein - A point of care test in the diagnosis of bacterial meningitis

Background: Bacterial meningitis is a significant life-threatening illness during infancy and childhood. Delay in distinguishing bacterial from viral or other aseptic meningoencephalitis may have irrevocable consequences. A typical case of pyogenic meningitis without prior antibiotics may not create any diagnostic problems, but prior treatment with inappropriate and inadequate antibiotics may cause sufficient alteration in biochemistry and cytology of cerebrospinal fluid (CSF), and organisms may not get isolated from blood or CSF culture. Objective: C-reactive protein in CSF (CSF-CRP) has been reported to be one of the most reliable and early indices to differentiate bacterial from non-bacterial meningitis. This study was undertaken to evaluate the diagnostic significance of CSF- CRP as an early indicator in the differentiation of bacterial from non-bacterial meningitis. Materials and Methods: This descriptive study was done in children in the age group of 1 month to 12 years who were admitted with history and clinical features suggestive of acute central nervous system infection. CSF was analyzed for macroscopic appearance, pleocytosis, proteins, and sugar content, Grams and Ziehl

Acute viral infections of the central nervous system, 2014‐2016, Greece

In order to investigate the viral etiology of acute infections of central nervous system (CNS), multiplex and single PCRs combined with serology for arboviruses were applied on samples from 132 hospitalized patients in Greece during May 2014-December 2016. A viral pathogen was detected in 52 of 132 (39.4%) cases with acute CNS infection. Enteroviruses predominated (15/52, 28.8%), followed by West Nile virus (9/52, 17.3%). Phleboviruses, varicella-zoster virus, and Epstein-Barr virus accounted for 15.4%, 13.5%, and 11.5% of the cases, respectively. The study gives an insight into the etiology of viral CNS infections in a Mediterranean country, where arboviruses should be included in the differential diagnosis of acute CNS infections.

Neuropsychological and internalizing problems in acute central nervous system infections: a 1 year follow-up

BackgroundAcute central nervous system (ACNS) infections such as meningitis, encephalitis and cerebellitis still cause morbidity and mortality among children. The aim of this study was to verify whether neuropsychological impairment may develop in ACNS survivors.MethodsThe study included pediatric patients affected by ACNS disorders, aged 3-16 years admitted to the Bambino Gesù Children Hospital, Rome from June 2013 till June 2015. The patients and their parents underwent a psychological interview and neuropsychological tests during the first week of hospital admission and 1 year after, during a follow-up control. Wilcoxon signed rank tests for paired data were conducted to verify if the results were statistically importance. Patients underwent a cognitive profile test through the Leiter international performance scale – revised, motor skills evaluation through the test of visual-motor integration and a psychopathological evaluation by the child behavior checklist. The K-SADS-PL test was administered in children 6-11 years old to check psychopathological disorders.ResultsForty-four patients were included in the study. At the 1 year follow-up, “anxiety problems” (dependency, fears, worries, nervousness) developed in 47% of patients, “somatic problems” (aches, headaches, nausea, vomiting) in 29% and “affective problems” (crying, self-harming, worthlessness, guilt, tiredness, sadness) in 29%. Visual perception was statistically increased at the 1 year follow-up in our patient cohort (p = 0.0297), mainly among the meningitides group (p = 0.0189). Motor-coordination also increased at the follow-up check in the study participants (p = 0.0076), especially in the group affected by cerebellitis (p = 0.0302).ConclusionsNeuropsychological disorders are often difficult to recognize in the early stage. They must, however, be promptly identified through specific and standardized neuropsychological examinations in order to avoid long term sequelae in adulthood.

Transcranial Color‐Coded Duplex in Acute Encephalitis: Current Status and Future Prospects

There are limited data regarding the diagnostic yield of transcranial color-coded Doppler (TCCD) in acute encephalitis. We present our preliminary observations of consecutive ultrasound evaluations in 2 patients with acute encephalitis and we review the possible diagnostic role of TCCD in such cases. We describe two cases of acute encephalitis that presented with aphasia and confusion and underwent repeat TCCD evaluation at baseline and after 48 hours in both patients. We also critically review the current literature regarding potential TCCD applications in acute central nervous system infections. Serial TCCD evaluations revealed the following triad of abnormal findings in both patients: (i) elevated pulsatility index (PI) in the left middle cerebral artery (M1 MCA) at baseline (>1.2), (ii) increased PI in left M1 MCA by >25% in comparison to right M1 MCA, and (iii) decrease in PI in left M1 MCA by >25% at the follow-up evaluation at 48 hours. The decrease in PI in left M1 MCA coincided with symptom improvement in both patients. The focal transient increase in left M1 MCA PI may be attributed to focally increased intracranial pressure or peripheral vasospasm of distal left MCA branches. Since there are limited reports in the literature concerning TCCD evaluation of patients with central nervous system infections, our preliminary findings require independent confirmation in a larger series of patients.

Diagnostic Practices for Suspected Acute Central Nervous System (CNS) Infection in Children in the Post Conjugate Vaccine Era, 2004-2014

Diagnostic Practices for Suspected Acute Central Nervous System (CNS) Infection in Children in the Post Conjugate Vaccine Era, 2004-2014

Melatonin, minocycline and ascorbic acid reduce oxidative stress and viral titers and increase survival rate in experimental Venezuelan equine encephalitis

Venezuelan equine encephalitis (VEE) virus causes an acute central nervous system infection in human and animals. Melatonin (MLT), minocycline (MIN) and ascorbic acid (AA) have been shown to have antiviral activities in experimental infections; however, the mechanisms involved are poorly studied. Therefore, the aim of this study was to determine the effects of those compounds on the viral titers, NO production and lipid peroxidation in the brain of mice and neuroblastoma cultures infected by VEE virus. Infected mouse (10 LD50) were treated with MLT (500μg/kg bw), MIN (50mg/kg bw) or AA (50mg/kg bw). Infected neuroblastoma cultures (MOI: 1); MLT: 0.5, 1, 5mM, MIN: 0.1, 0.2, 2μM or AA: 25, 50, 75μM. Brains were obtained at days 1, 3 and 5. In addition, survival rate of infected treated mice was also analyzed. Viral replication was determined by the plaque formation technique. NO and lipid peroxidation were measured by Griess׳ reaction and thiobarbituric acid assay respectively. Increased viral replication, NO production and lipid peroxidation were observed in both, infected brain and neuroblastoma cell cultures compared with uninfected controls. Those effects were diminished by the studied treatments. In addition, increased survival rate (50%) in treated infected animals compared with untreated infected mice (0%) was found. MLT, MIN and AA have an antiviral effect involving their anti-oxidant properties, and suggesting a potential use of these compounds for human VEE virus infection.

Managing acute central nervous system infections in the UK adult intensive care unit in the wake of UK encephalitis guidelines.

The acute central nervous system infections meningitis and encephalitis commonly require management on intensive care units. The clinical features often overlap and in the acute phase-altered consciousness and seizures may also need to be managed. In April 2012, the first UK national guideline for the management of suspected viral encephalitis was published by the British Infection Association and Association of British Neurologists, and other key stakeholders, and included a simple management algorithm. The new guideline results from evidence demonstrating a number of common oversights in the standard management of suspected viral encephalitis in many settings. In combination with British Infection Association meningitis guidelines, evidence-based approaches now exist to facilitate the non-expert managing patients with suspected central nervous system infections. Here we bring together these guidelines and the supporting evidence applicable for intensivists into a single resource.

Is the concept of central nervous system immune privilege irrelevant in the setting of acute infection?

While historically viewed as an immune-privileged area fully isolated from the immune system, the central nervous system (CNS) is now appreciated to maintain dynamic bi-directional communication with the immune system across the blood–brain barrier (BBB) (1, 2). In no setting can this communication be more urgent that acute CNS infection – a dampened or delayed host response could allow an invading virus or bacterium to gain a foothold within the brain, while over-exuberant or protracted inflammation might cause substantial collateral damage to sensitive and non-renewable cells such as neurons. In this opinion piece, we compare host immunity against one prototype virus and one prototype bacterium known to cause disease either outside or within the CNS. Allowing for some variability in disease pathogenesis, and leaving aside complex issues related to chronic intrauterine or neonatal infections, we argue that antimicrobial host responses in both CNS and non-CNS tissue compartments of adult hosts who acquire these infections exhibit many more similarities than differences. In this setting, the concept of CNS immune privilege seems antiquated.

Clinical significance of serum myocardial enzymes and CSF LDH detection in adults with intracranial infection

Objective To investigate the changes and clinical significance of serum lactate dehydrogenase (LDH), creatine kinase (CK), glutamate pyruvate transaminase (AST), and cerebrospinal fluid lactate dehydrogenase (CSF LDH) in adult patients with acute central nervous system infection. Methods The levels of myocardial enzymes (AST, LDH, and CK ) in serum of 96 adult patients with acute intracranial infection in 7days and 39 healthy people were measured by Beckman automatic biochemical analyzer and enzyme rate assay, and CSF LDH level in 96 patients were measured simultaneously. Results ⑴The serum myocardial enzymes (LDH, CK, and AST ) of intracranial infection group (47 cases with viral encephalitis, 30 cases with tuberculous meningitis, and 19 cases with purulent encephalitis) were significantly higher than those of normal control group (P 0.05). Conclusions ⑴There is significant change in the levels of serum LDH, CK, AST, and CSF LDH of adult patients with acute intracranial infection, especially in infected patients with cerebral functional disorder, and the change of LDH is the most obvious. ⑵The levels of serum myocardial enzymes and CSF LDH are helpful to the differential diagnosis of intracranial infection in early stage, and judging the severity of the illness. Key words: Tuberculosis, meningeal/ME; Meningitis, viral/ME; Meningitis, bacterial/ME; Lactate dehydrogenases/ME; Creatine kinase/ME; Aspartate aminotransferases/ME

Clobazam is a Better Option for Intermittent Prophylaxis of Febrile Convulsion

Aims: To compare safety and efficacy of diazepam and clobazam. Objectives: This study was undertaken to compare the effectiveness of intermittent clobazam versus diazepam therapy in preventing the recurrence of febrile convulsion and assess adverse effects of each drug.Methods: This is a hospital based randomized controlled trial was performed on neurologically normal children with the history of simple febrile convulsion and normal electroencephalogram without any evidence of acute central nervous system infection, done in Chattagram Maa Shishu-O-General Hospital/CMSOGH between November’12 to April’13. A total of 37 patients were randomly prescribed with oral clobazam and diazepam was given in 35 patients when they developed a febrile disease. All the patients were monitored regarding developing seizure and adverse effects of the drugs. All patients were followed for 12 months.Results: It was observed that 243 attacks of fever occurred during the period, including 116 attacks in the clobazam group and 127 episodes in the diazepam group. Recurrence of convulsion occurred in 2 (1.7%) subjects in the clobazam group, and in 4(3.1%) cases in the diazepam group. Twenty cases (54%) in the diazepam group and 5 (14.2% ) cases in the clobazam group developed drowsiness and sedation during the follow-up period.Conclusion: Intermittent clobazam therapy has better advantage over diazepam with similar efficacy but significantly lower adverse effects such as drowsiness and sedation.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i3.21027

Increased levels of sphingosine-1-phosphate in cerebrospinal fluid of patients diagnosed with tick-borne encephalitis.

BackgroundTick-borne encephalitis (TBE) is a serious acute central nervous system infection that can result in death or long-term neurological dysfunctions. We hypothesize that changes in sphingosine-1-phosphate (S1P) concentration occur during TBE development.MethodsS1P and interleukin-6 (IL-6) concentrations in blood plasma and cerebrospinal fluid (CSF) were measured using HPLC and ELISA, respectively. The effects of S1P on cytoskeletal structure and IL-6 production were assessed using rat astrocyte primary cultures with and without addition of plasma gelsolin and the S1P receptor antagonist fingolimod phosphate (FTY720P).ResultsWe report that acute inflammation due to TBE virus infection is associated with elevated levels of S1P and IL-6 in the CSF of infected patients. This elevated concentration is observed even at the earliest neurologic stage of disease, and may be controlled by glucocorticosteroid anti-inflammatory treatment, administered to patients unresponsive to antipyretic drugs and who suffer from a fever above 39°C. In vitro, treatment of confluent rat astrocyte monolayers with a high concentration of S1P (5 μM) results in cytoskeletal actin remodeling that can be prevented by the addition of recombinant plasma gelsolin, FTY720P, or their combination. Additionally, gelsolin and FTY720P significantly decreased S1P-induced release of IL-6.ConclusionsTBE is associated with increased concentration of S1P and IL-6 in CSF, and this increase might promote development of inflammation. The consequences of increased extracellular S1P can be modulated by gelsolin and FTY720P. Therefore, blocking the inflammatory response at sites of infection by agents modulating S1P pathways might aid in developing new strategies for TBE treatment.

Development history of herpes simplex encephalitis

Herpes simplex encephalitis (HSE) is an acute central nervous system infection caused by herpes simplex virus (HSV). Early clinical manifestations mainly include fever, headache and unconsciousness; when progressing, psychiatric symptoms can occur. Death or serious neurological sequelae will happen if not treated. With the development of laboratory tests and imaging techniques, the early diagnosis of HSE is possible. Even though imaging with temporal lobe abnormal signal has the implication to HSE, the application of polymerase chain reaction (PCR) in detecting HSV DNA in cerebrospinal fluid is currently the gold standard to diagnose HSE. Once diagnosed, acyclovir must be given as soon as possible, as delayed treatment will result in a poor outcome. doi: 10.3969/j.issn.1672-6731.2014.08.003

Etiology and prognosis of non-convulsive status epilepticus

Although non-convulsive status epilepticus (NCSE) is an important type of epilepsy, it is not often recognized. In order to analyze the clinical characteristics and outcome in patients with NCSE, we examined the medical records of patients with NCSE admitted to the Seoul National University Hospital between June 2005 and October 2008. The clinical details and electroencephalography records of 34 adult NCSE patients (aged over 16years) were collected. Their mean age was 47years (standard deviation 20years, range, 16–87years), and 20 were female. Twenty-seven patients (79.4%) showed decreased awareness with acute onset, and seven (20.6%) were obtunded or comatose. Ten patients (29.4%) had a history of epilepsy, and four (11.8%) had a history of stroke. NCSE was etiologically attributed to acute medical or neurological problems in 25 patients (73.5%), was cryptogenic in three (8.8%), and was secondary to underlying epilepsy in six (17.7%). Acute symptomatic etiology was associated with poor recovery (p=0.048), with all unresponsive patients in this acute symptomatic group. Eight (23.5%) of the 34 NCSE patients did not recover or died, whereas nine (26.5%) recovered. Our study shows that the presence of acute symptoms or central nervous system infection is associated with poor outcome, suggesting that a high level of vigilance is required to identify and prevent complications.

ABSTRACT 352

Background and aims: Role of various osmotherapy agents in treating children with raised intracranial pressure (ICP) due to acute central nervous system (CNS) infections is not well studied. Aims: Compare the 20%-Mannitol versus 3%-Hypertonic saline (HTS) in children with raised ICP due to acute CNS infections. Design: Prospective open label RCT in level-III PICU. Subjects: Children, aged 1–12 years with raised ICP and modified-GCS Score ≤8. Interventions: ICP was monitored using intraparenchymal microtransducer (Codman®). ICP above 20 mmHg was treated either with 20%-Mannitol, 0.5 gram/kg/dose over 20-min as and when required (Mannitol-Group, n=28) or 3%-HST, 10 ml/kg loading then 0.5–1 ml/kg/hr at sliding scale infusion (HTS-Group, n=29). Serum osmolarity of 330 mOsmol, sodium of 160 mEq/l were accepted. Outcomes: Primary: Efficacy of mannitol and HTS to bring ICP < 20 mmHg. Secondary: m-GCS score at 72-hrs and poor outcomes (death plus severe sequelae) at 3 months. Study registered with ctri.nic.in (CTRI/2011/09/001997). Results: Significant reduction in mean ICP (14 vs. 22 mmHg, p=0.010) with a corresponding increase in CPP (67 vs. 53 mmHg; p=0.001) was noted during 72-hrs in HTS-group as compared to Mannitol-group. HTS successfully controlled raised ICP in 79% of patients, in contrast to 50% by mannitol (RR=0.63, 95% CI 0.42–0.95; p=0.020). Median (IQR) m-GCS score was higher in HTS-group as compared to Mannitol-group (10 (7–11) vs. 7 (3–9); p=0.003). HTS-group had a lower poor outcome than Mannitol-group (34.5% vs. 68%) (RR=0.49, 95% CI 0.27 - 0.89; p=0.012). Conclusions: 3%-Saline was superior to 20%-Mannitol for controlling raised ICP in acute CNS infections.

Impact of health care providers’ advice on vaccine refusal for children with an acute nervous system infection

Sir, Based on a survey in infants’ parents and primary health care providers (HCP), Bakhache et al. underlined the influence of HCP on parental decisions to accept vaccination programs [1]. In the article, authors confirmed that the vast majority of interviewed HCP considered vaccines an important part of preventive care. Overall, 75 % of parents agreed that they trusted their HCP’s judgments about vaccine choices. We wonder whether parents’ nonacceptance of vaccination is influenced by HCP as well. We found out that HCP’s judgments may influence either the parents’ decision to immunize or not to immunize their child. This problem is particularly important when dealing with children recently affected by a severe infectious disease requiring hospitalization which, in most cases, would have been preventable by recommended vaccinations. We interviewed the parents of 40 children admitted to our Hospital (Bambino Gesu Children’s Hospital in Rome, Italy) from 1 December 2012 until 1 September 2013 because of acute central nervous system (ACNS) infection, including meningitis, encephalitis, and acute cerebellitis. Median age of the children was 3.3 years, and median hospital stay was 15 days, during which they received intravenous therapy and were subject to isolation measures. During the hospitalization and the medical visit 15 days after hospital discharge, we questioned parents about the vaccination of their children. Out of 40 patients, 10 had received the appropriate vaccines according to their age. Thirty parents did not complete the vaccination program for the following reasons: (1) lack of knowledge of the current vaccination program (18 cases), (2) inconvenient timing/parents’ forgetfulness (2 cases), and (3) advised against vaccination by HCP (10 cases). All parents reported having been seriously worried about their child’s health during hospitalization. We offered vaccination free of charge for unvaccinated children, explaining the benefits of immunization. Parents of 24 patients asked for immediate vaccination of their children. In six cases, parents refused vaccination for the following reasons: (1) vaccines are considered more dangerous than the diseases (2 cases), (2) vaccines are considered useless in most cases (1 case), (3) children have already benefited from herd immunity (1 case), (4) a child who has already experienced one ACNS infection is unlikely to contract another (1 case), and (5) the vaccine may cause cancer (1 case). All these parents stated that the reasons for their refusal were shared by their HCP. We fully support the conclusions of Bakhache et al. on the central role of HCP advice in providing disease education to parents. In fact, it is well known that HCP recommendation is a strong determinant of immunization success. However, parents frequently reported to have been advised against immunization by their HCP mainly due to erroneous contraindications. This finding raises concern that the communication process from HCP to family on immunization needs to be improved. Besides information programs on immunizations that target the general public, a thorough approach involving HCP education on safety and efficacy of vaccines and how to provide clear information to families is strongly needed Communicated by Willem Proesmans E. Bozzola (*) : L. Nicolosi :A. Vittucci :A. Villani Department of Pediatric, Pediatric and Infectious Diseases Unit, Bambino Gesu Children’s Hospital, IRCCS, Piazza Sant Onofrio 4, 00165 Rome, Italy e-mail: elena.bozzola@opbg.net

Enteroviral central nervous system infections in children treated at a hospital in Lima, Peru

To determine the frequency and clinical features of central nervous system infections caused by enterovirus in children treated at the Hospital Nacional Cayetano Heredia in Lima, Peru. A prospective, descriptive study was performed from April 2008 to March 2010. Patients aged 1 month - 14 years with clinical diagnosis of encephalitis or aseptic meningitis were included. We investigated the presence of enterovirus, herpes simplex virus 1 (HSV-1), herpes simplex virus 2 (HSV-2) and varicella-zoster virus (VZV) by polymerase chain reaction (PCR). 97 patients were included, out of which 69 % had acute encephalitis and 31 % acute meningitis. Enteroviruses were identified in 52,6% of all acute non-bacterial central nervous system infections; corresponding to 83,3 % of meningitis and 38,8 % of encephalitis. There were no cases of infection due to HSV-1, HSV-2 or VZV. Enterovirus infections reached 82,9 % in the warm months (November-January) and 28,6 % in the colder months (May-July). Enteroviruses are the principal etiologic agents in acute aseptic meningitis and encephalitis in pediatric patients in Lima, Peru. Enteroviruses have a seasonal epidemiological pattern with a clear increase in the number of cases during the summer months. It is useful to have this rapid diagnostic method available as an aid in the management of acute central nervous system infections.

Infecciones del sistema nervioso central por enterovirus en niños atendidos en un hospital de Lima, Perú

Objectives. To determine the frequency and clinical features of central nervous system infections caused by enterovirus in children treated at the Hospital Nacional Cayetano Heredia in Lima, Peru. Materials and methods. A prospective, descriptive study was performed from April 2008 to March 2010. Patients aged 1 month – 14 years with clinical diagnosis of encephalitis or aseptic meningitis were included. We investigated the presence of enterovirus, herpes simplex virus 1 (HSV-1), herpes simplex virus 2 (HSV-2) and varicella-zoster virus (VZV) by polymerase chain reaction (PCR). Results. 97 patients were included, out of which 69 % had acute encephalitis and 31 % acute meningitis. Enteroviruses were identified in 52,6% of all acute non-bacterial central nervous system infections; corresponding to 83,3 % of meningitis and 38,8 % of encephalitis. There were no cases of infection due to HSV-1, HSV-2 or VZV. Enterovirus infections reached 82,9 % in the warm months (November-January) and 28,6 % in the colder months (May-July). Conclusions. Enteroviruses are the principal etiologic agents in acute aseptic meningitis and encephalitis in pediatric patients in Lima, Peru. Enteroviruses have a seasonal epidemiological pattern with a clear increase in the number of cases during the summer months. It is useful to have this rapid diagnostic method available as an aid in the management of acute central nervous system infections.