Etiology of Central Nervous System Infections in a Rural Area of Nepal Using Molecular Approaches

Säll, Olof; Hedberg, Sara Thulin; Neander, Marita; Tiwari, Sabina; Dornon, Lester; Bom, Rabin; Lagerqvist, Nina; Sundqvist, Martin; Mölling, Paula

doi:10.4269/ajtmh.18-0434

Cited by 17 publications

(20 citation statements)

References 35 publications

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“…The MeningoFinder 2SMART (PathoFinder, Maastricht, the Netherlands), available for research use only, detects nine bacteria, twelve viruses and two fungi, has been compared with the Fil-mArray® ME panel in one study and was shown to be less sensitive for EV and Cryptococcus [31].…”

Section: Multiplex Pcr Panels: Analytical and Clinical Performancesmentioning

confidence: 99%

“…In resource-limited settings, where the expertise required to perform more labour-intensive molecular tests is often lacking, easyto-use multiplex PCR panels can improve CNS infection diagnostics [31,50,51], although the impact on antimicrobial use and management might be lower in this context [50]. Pulmonary tuberculosis diagnosis has been improved by the use of such a tool [52].…”

Section: Qualitative Versus Quantitative Assaysmentioning

confidence: 99%

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Diagnostic challenges of central nervous system infection: extensive multiplex panels versus stepwise guided approach

Vetter

Schibler

Herrmann

et al. 2020

Clinical Microbiology and Infection

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Background: Cerebrospinal fluid (CSF) testing is a key component for the diagnosis of central nervous system (CNS) infections. Current meningitis and encephalitis management guidelines agree on the need for CSF molecular testing in combination with other direct and indirect biological testing, both in CSF and blood. Multiplex molecular tests have been developed to reduce turnaround times and facilitate the diagnostic approach. Objectives: We aim to discuss the role of multiplex molecular panels in the management of CNS infections. Sources: The MEDLINE database and the grey literature have been searched for relevant articles. Content: New molecular multiplex panels are being developed to simultaneously detect a large array of neuropathogens in CSF. Although one of these assays has been US Food and Drug Administrationapproved, extensive analytical and clinical validation is still missing, and suboptimal performance related issues have been raised. Its use has been associated with decreased costs, reduced length of hospital stay and reduced antiviral therapy administration in retrospective, industry-sponsored studies. The pros and cons of this multiplex syndromic approach are discussed in this narrative review. Implications: Molecular multiplex CNS infection diagnosis panels have been developed and present several attractive features, including ease of use and low turnaround time. However, suboptimal analytical performances render these tests difficult to use without additional confirmatory tests. Such panels are not comprehensive nor adapted to all situations, depending on the epidemiological or clinical context. Overall, available data in the literature currently do not support the use of a multiplex PCR panel in clinical routine as a 'stand-alone' molecular assay. Except in restricted laboratory capacity settings where such easy-to-use multiplex panels offer the diagnostic means that would otherwise not be available, the stepwise testing approach remains a more rational option. Serological testing both in blood and CSF should not be neglected, but it represents essential complementary tools regarding some neuropathogens.

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Section: Multiplex Pcr Panels: Analytical and Clinical Performancesmentioning

confidence: 99%

Section: Qualitative Versus Quantitative Assaysmentioning

confidence: 99%

Diagnostic challenges of central nervous system infection: extensive multiplex panels versus stepwise guided approach

Vetter

Schibler

Herrmann

et al. 2020

Clinical Microbiology and Infection

View full text Add to dashboard Cite

show abstract

“…These two agents were not detected together in any patient. The rate of detection of HHV-6 in the CSF of children is reported in the range of 0.3-32% in the presence of sepsis, seizures, and neurological findings with fever and in the range of 3.3-4.2% in the presence of meningitis [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. HHV-7 is a rare aetiological agent in CNS infections in children, the rate of detection in CSF varies between 1% and 14.8%, and its incidence increases especially with increasing age [11,12,16,22,[25][26][27][28][29][30][31][32][33][34][35].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the detection of HHV-7 in 3 children older than the others brings to mind that HHV-7 reactivation may have developed in these children. It has been reported in the literature that reactivation of HHV-7 is seen rather than primary infection in adults [11,12,16,22,[24][25][26][27][28][29][30][31][32][33][34][35][36][37].…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of pediatric patients with Human Herpes Virus-6 and/or Human Herpes Virus-7 detected in cerebrospinal fluid: a single center experience

OKUR¹,

POTA²,

Güngör³

et al. 2022

Pamukkale Medical Journal

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Purpose: Human Herpes Virus-6, is a common cause of febrile seizures in infancy and has been associated with meningitis in this age group. Human Herpes Virus-7, may also cause meningitis in children. The role and frequency of HHV-6 and HHV-7 in children's central nervous system diseases is unclear and is an area of ongoing research. In our study, we aimed to contribute to the literature about effects of Human Herpes Virus-6 and Human Herpes Virus-7 in central nervous system infections, in children. Materials and methods:A retrospective study was conducted between March 2021 and March 2022. The study included children diagnosed with central nervous system infection and those found to have Human Herpes Virus-6 and or Human Herpes Virus-7 in their cerebrospinal fluid by multiplex real-time polymerase chain reaction. Results: In our study, 86 children were hospitalized with the diagnoses of central nervous system infection. We detected Human Herpes Virus-6 and/or Human Herpes Virus-7 in cerebrospinal fluid in 12 (13.9%) children. When the patients were grouped according to their age, 75% were under the age of 2 years. Seizure was the presenting complaint in all patients with Human Herpes Virus-6 and 50% patients with Human Herpes Virus-7. Although the frequency of seizures was lower in the Human Herpes Virus-7, 75% of the seizures in this group were status epilepticus. Cerebral venous thrombosis was observed in 3 patients. All patients with thrombosis were found to be infected with Human Herpes Virus-7. Conclusion: Our study findings show that Human Herpes Virus-6 and Human Herpes Virus-7 may be associated with central nervous system infections and severe neurological diseases in childhood. Our study makes an important contribution to the literature in this respect and shows the need for multicenter prospective studies.

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Enteric viruses circulating in undiagnosed central nervous system infections at tertiary hospital in São José do Rio Preto, São Paulo, Brazil

Rocha

Estofolete

Milhim

et al. 2020

Journal of Medical Virology

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Enterovirus (EV) is commonly associated with central nervous system (CNS) syndromes. Recently, gastroenteric viruses, including rotavirus (RVA), human astrovirus (HAstV), and norovirus (NoV), have also been associated with CNS neurological disorders. The aim of the present study was to investigate the presence of EV, RVA, HAst, and NoV associated to CNS infections with undiagnosed etiology in Northwest region of São Paulo State, Brazil, and to conduct the molecular characterization of the positive samples detected. A total of 288 cerebrospinal fluid samples collected from July to December 2017 were tested for EV and NoV by quantitative real‐time polymerase chain reaction (RT‐qPCR), HAstV by conventional RT‐PCR, and RVA by enzyme‐linked immunosorbent assay. Positive‐EV samples were inoculated in cells lines, amplified by RT‐PCR and sequenced. RVA, NoV, and HAstV were not detected. EV infection was detected in 5.5% (16/288), and five samples successful genotyped: echovirus 3 (E3) (1/5), coxsackie virus A6 (CVA6) (1/5), and coxsackie virus B4 (CVB4) (3/5). Meningitis was the main syndrome observed (12/16; 75%). CVA6, CVB4, and E3 were identified associated with aseptic meningitis. Reports of CVA6 associated with aseptic meningitis are rare, E3 had not been previously reported in Brazil, and epidemiological data on CVB4 in the country is virtually unknown. The present investigation illustrates the circulation of diverse EV types in a small regional sample set and in a short period of time, highlighting the importance of an active EV surveillance system in CNS infections. Enhanced understanding of undiagnosed CNS infections will assist in public health and health care planning.

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Etiology of Central Nervous System Infections in a Rural Area of Nepal Using Molecular Approaches

Cited by 17 publications

References 35 publications

Diagnostic challenges of central nervous system infection: extensive multiplex panels versus stepwise guided approach

Diagnostic challenges of central nervous system infection: extensive multiplex panels versus stepwise guided approach

Evaluation of pediatric patients with Human Herpes Virus-6 and/or Human Herpes Virus-7 detected in cerebrospinal fluid: a single center experience

Enteric viruses circulating in undiagnosed central nervous system infections at tertiary hospital in São José do Rio Preto, São Paulo, Brazil

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