Viral meningitis in Sudanese children: Differentiation, etiology and review of literature

Abstract

Diagnosis of viral meningitis (VM) is uncommon practice in Sudan and there is no local viral etiological map. We therefore intended to differentiate VM using standardized clinical codes and determine the involvement of herpes simplex virus types-1 and 2 (HSV-1/2), varicella zoster virus, non-polio human enteroviruses (HEVs), and human parechoviruses in meningeal infections in children in Sudan. This is a cross-sectional hospital-based study. Viral meningitis was differentiated in 503 suspected febrile attendee of Omdurman Hospital for Children following the criteria listed in the Clinical Case Definition for Aseptic/Viral Meningitis. Patients were children age 0 to 15 years. Viral nucleic acids (DNA/RNA) were extracted from cerebrospinal fluid (CSF) specimens using QIAamp® UltraSens Virus Technology. Complementary DNA was prepared from viral RNA using GoScriptTM Reverse Transcription System. Viral nucleic acids were amplified and detected using quantitative TaqMan® Real-Time and conventional polymerase chain reactions (PCRs). Hospital diagnosis of VM was assigned to 0%, when clinical codes were applied; we considered 3.2% as having VM among the total study population and as 40% among those with proven infectious meningitis. Two (0.4%) out of total 503 CSF specimens were positive for HSV-1; Ct values were 37.05 and 39.10 and virus copies were 652/PCR run (261 × 103/mL CSF) and 123/PCR run (49.3 × 103/mL CSF), respectively. Other 2 (0.4%) CSF specimens were positive for non-polio HEVs; Ct values were 37.70 and 38.30, and the approximate virus copies were 5E2/PCR run (~2E5/mL CSF) and 2E2/PCR run (~8E4/mL CSF), respectively. No genetic materials were detected for HSV-2, varicella zoster virus, and human parechoviruses. The diagnosis of VM was never assigned by the hospital despite fulfilling the clinical case definition. Virus detection rate was 10% among cases with proven infectious meningitis. Detected viruses were HSV-1 and non-polio HEVs. Positive virus PCRs in CSFs with normal cellular counts were seen.

Viral Meningitis (Enterovirus) Outbreak in The Pediatric Population of Sulaymaniyah Governorate, Iraq: A Multi-Center Experience

“…In multi-centered study, the gender-based prevalence of the disease skews noticeably towards males at 64.7%. Previous research from different geographic cohorts have occasionally highlighted such a gender disparity [9,[16][17][18][19]. While hormonal, biological, and immunological variances between genders could potentially factor in, the role of socio-cultural elements cannot be marginalized.…”

“…Globally, the patterns and impacts of enterovirus meningitis (EVM) vary widely. Factors like regional healthcare infrastructure, public health initiatives, climate, population density, and cultural practices can influence the incidence, clinical manifestations, and outcomes of this disease [9]. Despite the global scale of the issue, a comprehensive understanding of EVM remains fragmented.…”

Human parechovirus meningitis in children: state of the art

“…Incidence of HPeV meningitis in the African continent seemed to be low. In Sudan, between December and August 2010 no patient was found positive for HPeV on CSF, out of 503 children aged 0 to 15 years presenting with fever, seizures, and a suspicion of neuroinfection [ 42 ]. Nine years later in the Comoros archipelago, HPeV RT-PCR were performed on 122 CSFs, of which 77 were collected from children, and only a 30-days-aged infant presented with a CSF HPeV infection (0,8%) [ 43 ].…”

“…Blood analysis on 2 cases showed respectively WBCc of 5700 and 6500/mmc, CRP not elevated in the first case and mildly elevated in the second. CSF protein values were respectively normal and mildly elevated Epidemiology Abdelrahim NA, 2022 [ 42 ] Cross-sectional study Sudan (Africa) Between December and August 2010, 0/503, febrile children tested positive for HPeV in CSF Epidemiology Fourgeaud J, 2022 [ 43 ] Retrospective study Comoros (Africa) Between March and June 2019 only 1/122 CSF tested positive for HPeV, collected from a 30-days-aged infant in early June Clinical Presentation Laboratory Outcome Garrido R, 2022 [ 44 ] Case Report Portugal (Europe) An 11-day-old infant with fever, irritability, and poor feeding, CSF pleocytosis and increased protein level recovered well. At 18 months follow up, she was in health Clinical Presentation Laboratory Imaging Therapy Fox B, 2022 [ 45 ] Case Report Argentina (America) In the reported three cases, symptoms were fever, decreased oral intake, irritability, rash, seizures, bradycardia, desaturation, abdominal tenderness.…”

Progress in etiological diagnosis of viral meningitis

“…The virus has more than 60 different subtypes, including poliovirus, coxsackievirus A, coxsackievirus B, and echovirus ( 12 – 14 ). And others such as herpes simplex virus (HSV) and varicella-zoster virus (VZV) are also common pathogens causing this disease ( 15 – 17 ), but mumps virus and influenza virus are relatively rare. During the COVID pandemic, despite being reported, the incident rate of meningitis caused by SARS-CoV-2 seems extremely low.…”