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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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Overlap between possible viral, bacterial or malarial infection in Papua New Guinean children with possible central nervous system infection. The identified viral agent or species are shown in the boxes.
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Fig2: Overlap between possible viral, bacterial or malarial infection in Papua New Guinean children with possible central nervous system infection. The identified viral agent or species are shown in the boxes.

Mentions: Fifty-five of the 300 children (18%) had at least one type of viral or bacterial NA identified in their CSF, of which 42 had at least one virus identified, including 39 and three with single- and dual infections, respectively. Overlap between viral NA, bacterial NA and malaria was common (Figure 2). Bacterial DNA was identified in 20 children, with 7 of these also with viral NA present. Children with bacterial infection included 14, 5 and 1 with SP, HI and both SP/HI, respectively. Malaria was identified in 93 children (31%). An etiologic agent was not identified in 176 children (59%). The characteristics of children by likely etiologic agent according to malaria status are summarized in Table 1. After adjustment for age, the presence of viral and bacterial NA was associated with malaria infection (odds ratio [OR] 2.05 [95% confidence interval (CI95)] 1.03-4.08, P = 0.04 and 2.62 [1.02-6.8], P = 0.04, respectively).Figure 2


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)

Overlap between possible viral, bacterial or malarial infection in Papua New Guinean children with possible central nervous system infection. The identified viral agent or species are shown in the boxes.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Overlap between possible viral, bacterial or malarial infection in Papua New Guinean children with possible central nervous system infection. The identified viral agent or species are shown in the boxes.
Mentions: Fifty-five of the 300 children (18%) had at least one type of viral or bacterial NA identified in their CSF, of which 42 had at least one virus identified, including 39 and three with single- and dual infections, respectively. Overlap between viral NA, bacterial NA and malaria was common (Figure 2). Bacterial DNA was identified in 20 children, with 7 of these also with viral NA present. Children with bacterial infection included 14, 5 and 1 with SP, HI and both SP/HI, respectively. Malaria was identified in 93 children (31%). An etiologic agent was not identified in 176 children (59%). The characteristics of children by likely etiologic agent according to malaria status are summarized in Table 1. After adjustment for age, the presence of viral and bacterial NA was associated with malaria infection (odds ratio [OR] 2.05 [95% confidence interval (CI95)] 1.03-4.08, P = 0.04 and 2.62 [1.02-6.8], P = 0.04, respectively).Figure 2

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