Etiologic Agents of Central Nervous System Infections among Febrile Hospitalized Patients in the Country of Georgia

Abstract

ObjectivesThere is a large spectrum of viral, bacterial, fungal, and prion pathogens that cause central nervous system (CNS) infections. As such, identification of the etiological agent requires multiple laboratory tests and accurate diagnosis requires clinical and epidemiological information. This hospital-based study aimed to determine the main causes of acute meningitis and encephalitis and enhance laboratory capacity for CNS infection diagnosis.MethodsChildren and adults patients clinically diagnosed with meningitis or encephalitis were enrolled at four reference health centers. Cerebrospinal fluid (CSF) was collected for bacterial culture, and in-house and multiplex RT-PCR testing was conducted for herpes simplex virus (HSV) types 1 and 2, mumps virus, enterovirus, varicella zoster virus (VZV), Streptococcus pneumoniae, HiB and Neisseria meningitidis.ResultsOut of 140 enrolled patients, the mean age was 23.9 years, and 58% were children. Bacterial or viral etiologies were determined in 51% of patients. Five Streptococcus pneumoniae cultures were isolated from CSF. Based on in-house PCR analysis, 25 patients were positive for S. pneumoniae, 6 for N. meningitidis, and 1 for H. influenzae. Viral multiplex PCR identified infections with enterovirus (n = 26), VZV (n = 4), and HSV-1 (n = 2). No patient was positive for mumps or HSV-2.ConclusionsStudy findings indicate that S. pneumoniae and enteroviruses are the main etiologies in this patient cohort. The utility of molecular diagnostics for pathogen identification combined with the knowledge provided by the investigation may improve health outcomes of CNS infection cases in Georgia.

Combined testing for herpes simplex virus and Mycobacterium tuberculosis DNA in cerebrospinal fluid of patients with aseptic meningitis in Burkina Faso, West Africa

“…A similar study conducted in Bonn University Hospital, Bonn, Germany, reported a prevalence of 0.3% for HSV . Other studies reported a prevalence of 1.5% for HSV1 in Korea and 1.4% in Georgia . HSV1 was also reported in 3.4% and 6.5% in two studies conducted in adults living in Vietnam .…”

“…38 Other studies reported a prevalence of 1.5% for HSV1 in Korea 39 and 1.4% in Georgia. 40 HSV1 was also reported in 3.4% and 6.5%…”

Investigation of the Causative Agents of Meningitis By Real-Time PCR Method

“…PCR gibi amplifikasyon temelli yöntemlerle, viral nükleik asidin BOS'da saptanması, SSS enfeksiyonlarının tanısında önemli bir dönüm noktası olmuş ve böylece viral etkenleri belirlemedeki başarı %20-30'lardan, günümüzde %50-70'lere ulaşmıştır (8) . BOS'da PCR yöntemiyle etken arama, HSV, CMV ve enteroviral menenjit tanısı için önerilen tanı yöntemidir (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) . HSV menenjitleri, viral menenjitlerin %1-3'ünü oluşturur.…”

“…Erken tanı ve tedavinin son derece önemli olduğu bu hastalıkta menenjit bulguları ile gelen olgular hızla değerlendirilmeli ve hemen uygun antimikrobiyal tedavi başlanmalıdır. Bu sayede ölüm oranını azaltmak ve komplikasyonsuz iyileşmeyi artırmak olası olmaktadır (13,14) . Bakteriyel menenjit şüphesi olan hastada rutin tanı koyma yöntemi, BOS Gram boyama ve BOS kültürü-dür.…”

Hospital-Based Surveillance for Infectious Etiologies Among Patients with Acute Febrile Illness in Georgia, 2008–2011

“…Despite a recent publication in Georgia suggesting that this virus may be an etiologic agent for central nervous system infections, no published data are available on the burden of TBEV in Georgia. 24 The presence of the tick vector, however, is documented in the southern Caucasus. 25 Accordingly, our risk factor analysis identified tick bites as a risk factor for TBEV.…”