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Viral pathogens in children hospitalized with features of central nervous system infection in a malaria-endemic region of Papua New Guinea.

Laman M, Hwaiwhanje I, Bona C, Warrel J, Aipit S, Smith D, Noronha J, Siba P, Mueller I, Betuela I, Davis TM, Manning L - BMC Infect. Dis. (2014)

Bottom Line: 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.However most HHVs in this malaria-endemic setting should be considered to be the result of reactivation from a latent reservoir without clinical sequelae.

View Article: PubMed Central - PubMed

Affiliation: School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia. drmlaman@yahoo.com.

ABSTRACT

Background: 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.

Methods: We 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.

Results: Fifty-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.

Conclusion: Infections 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.

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Related in: MedlinePlus

Study profile outlining investigations performed on cerebrospinal fluid of Papua New Guinean children with possible central nervous system infection.
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Fig1: Study profile outlining investigations performed on cerebrospinal fluid of Papua New Guinean children with possible central nervous system infection.

Mentions: Cerebrospinal fluid was collected under sterile conditions and examined using standard microbiological procedures [12]. In brief, an Improved Neubauer Counting Chamber was used to count CSF leukocytes. All CSF with leukocyte counts ≥10 cells/μL were plated onto blood and chocolate agar for bacteriological culture. Cerebrospinal fluid samples with no cultured pathogen underwent latex agglutination testing (Wellcogen™, Remel Europe Limited, UK). Protein and glucose were measured using semi-quantitative dipstick tests. Blood cultures were taken and placed into an automated blood culture incubator (Bactec 9050, BD®). Patients with bacteria or fungus identified from CSF, blood cultures or by latex agglutination were excluded from further analysis (Figure 1).Figure 1


Viral pathogens in children hospitalized with features of central nervous system infection in a malaria-endemic region of Papua New Guinea.

Laman M, Hwaiwhanje I, Bona C, Warrel J, Aipit S, Smith D, Noronha J, Siba P, Mueller I, Betuela I, Davis TM, Manning L - BMC Infect. Dis. (2014)

Study profile outlining investigations performed on cerebrospinal fluid of Papua New Guinean children with possible central nervous system infection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4260243&req=5

Fig1: Study profile outlining investigations performed on cerebrospinal fluid of Papua New Guinean children with possible central nervous system infection.
Mentions: Cerebrospinal fluid was collected under sterile conditions and examined using standard microbiological procedures [12]. In brief, an Improved Neubauer Counting Chamber was used to count CSF leukocytes. All CSF with leukocyte counts ≥10 cells/μL were plated onto blood and chocolate agar for bacteriological culture. Cerebrospinal fluid samples with no cultured pathogen underwent latex agglutination testing (Wellcogen™, Remel Europe Limited, UK). Protein and glucose were measured using semi-quantitative dipstick tests. Blood cultures were taken and placed into an automated blood culture incubator (Bactec 9050, BD®). Patients with bacteria or fungus identified from CSF, blood cultures or by latex agglutination were excluded from further analysis (Figure 1).Figure 1

Bottom Line: 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.However most HHVs in this malaria-endemic setting should be considered to be the result of reactivation from a latent reservoir without clinical sequelae.

View Article: PubMed Central - PubMed

Affiliation: School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia. drmlaman@yahoo.com.

ABSTRACT

Background: 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.

Methods: We 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.

Results: Fifty-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.

Conclusion: Infections 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.

Show MeSH
Related in: MedlinePlus