Detection of central nervous system viral infections in adults in Manado, North Sulawesi, Indonesia

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.

Birth prevalence and characteristics of congenital cytomegalovirus infection in an urban birth cohort, Jakarta, Indonesia

“…Overall, 5.8% (24/411, 95% CI 3.9À8.7%) of neonates were confirmed to have congenital CMV infection by pan-herpesvirus PCR and Sanger sequencing of PCR product in at least one type of specimen. No other pathogens were identified, although the panherpesvirus PCR can detect a broad range of herpesviruses including herpes simplex virus, Epstein-Barr virus, and varicellazoster virus (Anthony et al, 2015;Mawuntu et al, 2018).…”

“…All saliva and urine specimens were tested for the presence of CMV DNA by using pan-herpesvirus nested-PCR as described previously (Chmielewicz et al, 2001;Mawuntu et al, 2018). Briefly, total nucleic acids were extracted by using QIAamp MinElute Virus Spin Kit (Qiagen, Hilden, Germany) from 200 ml of specimens.…”

“…PCR amplicons from patient samples with expected size (419 base pair) were further purified and sequenced with TS-TERM_708s and TS-TERM_708as primer pair by Sanger sequencing method in at least one type of specimen to confirm the identification of human CMV. The technical sensitivity of this pan-herpesvirus nested-PCR has previously been determined by our lab to be able to detect at least one copy of in-house CMV DNA control with known concentration derived from purified PCR product of human CMV cell culture isolate (Mawuntu et al, 2018). This assay sensitivity has not been compared to any commercial CMV detection kit.…”

Viral Encephalitis: A Hard Nut to Crack

“…26,39,43,44 Globally, majority of studies have concluded that herpes simplex virus (HSV) is the most prevalent cause of VE. 4,12,25,43,[45][46][47][48][49][50][51][52][53][54][55][56] The pathogenic agents of VE vary from country to country. In Western countries such as France, England, and the United States, human simplex virus-1(HSV-1) has come up as the most prominent cause of sporadic VE.…”

“…Thus, initial serological assays screening is recommended before sending the samples to higher laboratories. 56,122 Reverse Transcription PCR When ribonucleic acid (RNA) viruses have to be traced out, reverse transcription PCR comes into picture. It is similar to conventional PCR except for the first step where complimentary DNA (cDNA) is formulated out of RNA.…”