Outbreak of central nervous system infections among children in Thai Binh, Viet Nam

Abstract

From July to October 2020, 99 cases of central nervous system (CNS) infections were identified in Thai Binh Pediatric Hospital, Viet Nam, representing a five-fold increase compared to the baseline incidence during the previous five years. Clinical data were retrospectively collected. Cerebrospinal fluid specimens (CSF) were secondarily tested for pathogens using viral culture and PCR assays. Patient median age was 5 years (0–12 years); 58.6% were male. Of these children, 83.8% had CSF white blood culture (WBC) counts of ≥ 10 cells/µL, including 58 of 99 (58.6%) with a WBC count ≥ 100 cells/µL. Overall, 72 (72.7%) patients had confirmed infections with a pathogen identified in the CSF, the majority of which (66) were enterovirus. Sequencing results suggested that the rise of incidence observed in 2020 was due to Echovirus 4 ( n = 45), Echovirus 30 ( n = 8), and Echovirus 6 ( n = 1) circulation. A confirmed CNS infection was significantly associated with older age (≥5 years, OR = 3.64, p = 0.03) and with an increased WBC count in the CSF (OR = 6.38, p -value = 0.01 for WBCs from 10 to <100 and OR = 7.90, p -value = 0.002 for WBCs ≥100). Ninety-seven (97) of 99 (98.0%) children received empiric antimicrobial treatment, and 35 (35.3%) were treated with multiple antibiotics. Eighty-four (84) patients (84.9%) were discharged home, and 11 (11.1%) were transferred to the National Hospital because their condition had worsened. No deaths were recorded. Point-of-care tests, including real-time PCR assays to identify common pathogens, should be implemented for more accurate diagnosis and more appropriate antibiotic use.

Human Enterovirus B Is a Significant Cause of Aseptic Meningitis and Sepsis-Like Illness in Young Infants in Thailand

“…Our study highlights the circulation of EV-B, and less frequently EV-A, in pediatric cases with aseptic meningitis and sepsis-like illness, as previously noted in other studies [19,20]. The viral strains in this study were very similar to those identified in previous years in China, Taiwan, Vietnam, and Cambodia [21][22][23][24][25].…”

Aetiology of Acute Undifferentiated Fever Among Children Under the Age of Five in Vietnam: A Prospective Study

“…This is likely to underestimate the true burden of enterovirus in this study, since respiratory, skin, cerebrospinal fluid (CSF) and stool samples were not collected in patients with relevant symptoms. In a previous study conducted among children in Thai Binh hospitalised for central nervous system infections, enterovirus was found in the CSF in 67% of cases [ 26 ]. Interestingly, the highest rates (41–42%) were observed in patients with hand, foot and mouth disease and AUF.…”

Progress in etiological diagnosis of viral meningitis

“…Laboratory diagnostic methods include microscopic examination of clinical specimens, viral culture, serological studies, immunodetection of viral or viral antigens and even sequence reading of DNA or RNA ( 18 ). Early sample sizes were limited and virus concentrations were low, severely hindering accurate detection of pathogens by microscopy.…”