Cerebrospinal fluid viral etiology of patients with suspected central nervous system infections during the COVID-19 outbreak

Abstract

Purpose: Although viral etiology of central nervous system (CNS) infections such as meningitis and encephalitis are investigated widely worldwide, it remains to be declared under the COVID-19 pandemic. In this study, we aimed to investigate the etiology of viral CNS infections in patients hospitalized in a single referral hospital during the outbreak in Iran. Methods: We retrospectively collected the CSF samples and reviewed the medical records of patients hospitalized with suspected viral CNS infection in Shiraz, a large city in southern Iran, from April 2021 to May 2022. One hundred sixty-six cerebrospinal fluid (CSF) samples were tested primarily for detection of HSV 1 and 2 and were retrospectively analyzed by primers PCR targeted to coronavirus 2 (SARS-COV-2), human herpesviruses 1 to 6 (HHV-1 to -6), polyomaviruses JC, and enteroviruses (EV). Results: Of the total CSF samples analyzed by PCR, 22 (13.3%) were positive for only one viral pathogen, and just one (0.6%) sample was detected with multiple viruses (HSV-1 and CMV). The SARS-COV-2 (n=6) was the second most common viral etiology just after Herpes simplex virus (HSV-1) 6.6% (11 cases). Other detected viruses were CMV for 1.8% (3), VZV for 1.2 % (2), and JC for 0.6% (1) of the cases. Conclusion: According to the above, the spread of SARS-COV-2 during the COVID-19 pandemic, alongside HSV-1, CMV, and VZV in Iran, was significant. As a result, it can play an essential role in development of CNS-related diseases, which required urgent diagnosis and treatment.