The aetiologies of central nervous system infections in hospitalised Cambodian children

Abstract

BackgroundCentral nervous system (CNS) infections are an important cause of childhood morbidity and mortality. The aetiologies of these potentially vaccine-preventable infections have not been well established in Cambodia.MethodsWe did a one year prospective study of children hospitalised with suspected CNS infection at Angkor Hospital for Children, Siem Reap. Cerebrospinal fluid specimens (CSF) samples underwent culture, multiplex PCR and serological analysis to identify a range of bacterial and viral pathogens. Viral metagenomics was performed on a subset of pathogen negative specimens.ResultsBetween 1st October 2014 and 30th September 2015, 284 analysable patients were enrolled. The median patient age was 2.6 years; 62.0% were aged <5 years. CSF white blood cell count was ≥10 cells/μL in 116/272 (42.6%) cases. CNS infection was microbiologically confirmed in 55 children (19.3%). Enteroviruses (21/55), Japanese encephalitis virus (17/55), and Streptococcus pneumoniae (7/55) accounted for 45 (81.8%) of all pathogens identified. Of the pathogens detected, 74.5% (41/55) were viruses and 23.6% (13/55) were bacteria. The majority of patients were treated with ceftriaxone empirically. The case fatality rate was 2.5%.ConclusionsEnteroviruses, JEV and S. pneumoniae are the most frequently detected causes of CNS infection in hospitalised Cambodian children.

Serological Evidence for Japanese Encephalitis and West Nile Virus Infections in Domestic Birds in Cambodia

“…The direct detection of WNV in poultry, humans or mosquitoes as thorough evidence is still missing. The global distribution of WNV in tropical and temperate regions of Europe, Africa, the Americas, Western and central Asia is well-documented (17,18,55). In Southeast Asia, the main encephalitic flavivirus is still JEV (56).…”

“…With regards to JEV, two experimental studies suggest that young ducks and chickens might produce a sufficient viremia to infect mosquitoes when biting (14,15). Because of their close association to humans, and the varying levels of seroprevalence observed in domestic birds, their role in the epidemiological cycle as secondary reservoirs may be of importance (16)(17)(18).…”

Metagenome Analysis as a Tool to Study Bacterial Infection Associated with Acute Surgical Abdomen

“…The metagenome analysis has been performed to investigate the etiological agents of inflammatory diseases [ 19 , 20 ] in patients with sepsis [ 21 ], in neutropenic patients [ 22 ] and in children with central nervous system infection [ 23 ]. In a study of six patients with acute cholecystitis, the results of metagenome analysis from subjects with bacteria in bile were consistent with the results from conventional culture examination and antimicrobial susceptibility testing [ 13 ].…”

Role of Viral Agents in Childhood Central Nervous System Infections

“…This accords with previous studies on viral agents in CNS infections, where males have accounted for 55 to 65% of the positive cases, although the reason for this sex difference is unknown. 16,19,20 We found that all viral agents were most frequently detected in patients under 5 years of age. The mean ages of patients with EVs and herpesviruses were 4.07 AE 4.51 and 2.7 AE 3.88 years, respectively.…”