Enteroviral infections of the central nervous system observed in Bulgaria during five consecutive seasons

Abstract

Aim: Enteroviruses target various organs and systems of the human body, including the central nervous system (CNS). The aim of the present study was to better understand the clinical features of enteroviral infections of the CNS and the factors influencing the clinical course of disease.Material and methods: A total of 39 patients, aged 3-16 years, admitted to the Clinic of Infectious Diseases, University Hospital in Stara Zagora, Bulgaria, between 2012-2017 with confirmed enteroviral neuroinfection were enrolled in the study. Diagnosis was confirmed by laboratory and virological tests. Instrumental investigation was performed if needed. Results: In all cases the disease began suddenly and severely followed by hospitalization within 24 hours. Meningo-radicular syndrome was observed in 25 patients and sustained for average 4,1±1,9 days. Cerebrospinal fluid (CSF) showed pleocytosis in all cases ranging from 57 to 843.106/L, in 9 patients segmented cells predominated at the first lumbar puncture. Mild proteinorachie (0,50 to 0,76 g/L) was found in 17 of the patients. Virological tests revealed echovirus 30 and coxsackievirus B in 24 and 4 patients, respectively. Discussion: All cases in the study fulfill the criteria for a confirmed enteroviralinduced disease. Echovirus 30 was the predominant causative agent, affecting mainly children between 3 and 9 years old. All patients have gone as meningitis. The majority of them had moderate clinical course. Predominance of plymorphonuclear cells in the first lumbar punctate was found in 23% of the patients. All cases had a favorable outcome.