Surveillance of Viral Encephalitis in the Context of COVID-19: A One-Year Observational Study among Hospitalized Patients in Dakar, Senegal

Abstract

The burden of encephalitis and its associated viral etiology is poorly described in Africa. Moreover, neurological manifestations of COVID-19 are increasingly reported in many countries, but less so in Africa. Our prospective study aimed to characterize the main viral etiologies of patients hospitalized for encephalitis in two hospitals in Dakar. From January to December 2021, all adult patients that met the inclusion criteria for clinical infectious encephalitis were enrolled. Cerebrospinal fluids, blood, and nasopharyngeal swabs were taken and tested for 27 viruses. During the study period, 122 patients were enrolled. Viral etiology was confirmed or probable in 27 patients (22.1%), with SARS-CoV-2 (n = 8), HSV-1 (n = 7), HHV-7 (n = 5), and EBV (n = 4) being the most detected viruses. Age groups 40–49 was more likely to be positive for at least one virus with an odds ratio of 7.7. The mortality was high among infected patients, with 11 (41%) deaths notified during hospitalization. Interestingly, SARS-CoV-2 was the most prevalent virus in hospitalized patients presenting with encephalitis. Our results reveal the crucial need to establish a country-wide surveillance of encephalitis in Senegal to estimate the burden of this disease in our population and implement strategies to improve care and reduce mortality.

Clinical epidemiology, determinants, and outcomes of viral encephalitis in Ghana; a cross-sectional study

“…This observation has not been described elsewhere and contrasts the findings of several studies [ 25 – 27 ] that seem to suggest that males are more susceptible to viral encephalitis and usually experience a bad outcome. The underlying cause for this observation remains unclear; however, it aligns with the findings of a study conducted in Senegal [ 28 ] suggesting that racial and geographic disparities could contribute to the observed differences between studies conducted in Africa and those conducted elsewhere. The frequent administration of antibiotics could also partly explain the observed disparity.…”

Global Landscape of Encephalitis: Key Priorities to Reduce Future Disease Burden

“…Data on acyclovir availability from Africa are sparse, but the lack of availability of other more “basic” medications indicates this is likely also the case for acyclovir. IV acyclovir was not available in a study in Senegal: patients with HSE were given oral acyclovir or valaciclovir instead with resulting high mortality rates [ 55 ]. LMICs often experience poor availability of essential medicines in health facilities, substandard-quality treatments, frequent stock-outs, and suboptimal prescription and use of medicines, poor transportation systems, lack of drug storage facilities, and weak manufacturing capacity [ 56 ].…”

Encephalitis: diagnosis, management and recent advances in the field of encephalitides

“…84 85 A large challenge faced in sub-Saharan Africa is the lack of access to injectable aciclovir. 84 A potential compromise is oral valaciclovir which may be a more readily accessible alternative to intravenous aciclovir in settings with limited resources, although more robust studies are required to assess whether its efficacy is comparable. [86][87][88] Tackling disparity in access to important medications globally is huge challenge, and one which will need to be solved to help improve encephalitis management in low-income to middle-income/resource settings.…”

“…The aetiology of infectious encephalitis remains poorly described in African settings. In resource-limited settings such as Senegal, it was reported that encephalitis cases rarely have an aetiological diagnosis and treatment can often be inconsistent 84 85. A large challenge faced in sub-Saharan Africa is the lack of access to injectable aciclovir 84.…”

“…In resource-limited settings such as Senegal, it was reported that encephalitis cases rarely have an aetiological diagnosis and treatment can often be inconsistent 84 85. A large challenge faced in sub-Saharan Africa is the lack of access to injectable aciclovir 84. A potential compromise is oral valaciclovir which may be a more readily accessible alternative to intravenous aciclovir in settings with limited resources, although more robust studies are required to assess whether its efficacy is comparable 86–88.…”