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Etiology of Central Nervous System Infections in a Rural Area of Nepal Using Molecular Approaches
Örebro University, School of Medical Sciences. Department of Infectious Diseases.ORCID iD: 0000-0003-1999-3383
Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
United Mission Hospital Tansen, Tansen, Nepal.
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2019 (English)In: American Journal of Tropical Medicine and Hygiene, ISSN 0002-9637, E-ISSN 1476-1645, Vol. 101, no 1, p. 253-259Article in journal (Refereed) Published
Abstract [en]

The etiology of infections of the central nervous system (CNS) in Nepal often remains unrecognized because of underdeveloped laboratory facilities. The aim of this study was to investigate the etiology of CNS infections in a rural area of Nepal using molecular methods. From November 2014 to February 2016, cerebrospinal fluid (CSF) was collected from 176 consecutive patients presenting at United Mission Hospital in Tansen, Nepal, with symptoms of possible CNS infection. After the CSF samples were stored and transported frozen, polymerase chain reaction (PCR) was performed in Sweden, targeting a total of 26 pathogens using the FilmArray® ME panel (BioFire, bioMerieux, Salt Lake City, UT), the MeningoFinder® 2SMART (PathoFinder, Maastricht, The Netherlands), and an in-house PCR test for dengue virus (DENV), Japanese encephalitis virus (JEV), and Nipah virus (NiV). The etiology could be determined in 23%. The bacteria detected were Haemophilus influenzae (n = 5), Streptococcus pneumoniae (n = 4), and Neisseria meningitidis (n = 1). The most common virus was enterovirus detected in eight samples, all during the monsoon season. Other viruses detected were cytomegalovirus (n = 6), varicella zoster virus (n = 5), Epstein-Barr virus (n = 3), herpes simplex virus (HSV) type 1 (HSV-1) (n = 3), HSV-2 (n = 3), human herpes virus (HHV) type 6 (HHV-6) (n = 3), and HHV-7 (n = 2). Cryptococcus neoformans/gatti was found in four samples. None of the samples were positive for DENV, JEV, or NiV. Of the patients, 67% had been exposed to antibiotics before lumbar puncture. In conclusion, the etiology could not be found in 77% of the samples, indicating that the commercial PCR panels used are not suitable in this setting. Future studies on the etiology of CNS infections in Nepal could include metagenomic techniques.

Place, publisher, year, edition, pages
HighWire Press , 2019. Vol. 101, no 1, p. 253-259
National Category
Infectious Medicine
Identifiers
URN: urn:nbn:se:oru:diva-74617DOI: 10.4269/ajtmh.18-0434ISI: 000476680300040PubMedID: 31162021Scopus ID: 2-s2.0-85068911912OAI: oai:DiVA.org:oru-74617DiVA, id: diva2:1320796
Funder
Swedish Society of Medicine
Note

Funding Agencies:

Region Örebro County's Research Committe

Örebro University

Folke Nordbring Foundation

Available from: 2019-06-05 Created: 2019-06-05 Last updated: 2019-08-12Bibliographically approved

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Säll, OlofSundqvist, Martin

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