Herpes simplex virus meningitis in children in South East of caspian sea, iran

Etiology, Clinical Phenotypes, Epidemiological Correlates, Laboratory Biomarkers and Diagnostic Challenges of Pediatric Viral Meningitis: Descriptive Review

Meningitis is an inflammation of the brain and spinal cord meninges caused by infectious and non-infectious agents. Infectious agents causing meningitis include viruses, bacteria, and fungi. Viral meningitis (VM), also termed aseptic meningitis, is caused by some viruses, such as enteroviruses (EVs), herpesviruses, influenza viruses, and arboviruses. However, EVs represent the primary cause of VM. The clinical symptoms of this neurological disorder may rapidly be observed after the onset of the disease, or take prolonged time to develop. The primary clinical manifestations of VM include common flu-like symptoms of headache, photophobia, fever, nuchal rigidity, myalgia, and fatigue. The severity of these symptoms depends on the patient's age; they are more severe among infants and children. The course of infection of VM varies between asymptomatic, mild, critically ill, and fatal disease. Morbidities and mortalities of VM are dependent on the early recognition and treatment of the disease. There were no significant distinctions in the clinical phenotypes and symptoms between VM and meningitis due to other causative agents. To date, the pathophysiological mechanisms of VM are unclear. In this scientific communication, a descriptive review was performed to give an overview of pediatric viral meningitis (PVM). PVM may occasionally result in severe neurological consequences such as mental retardation and death. Clinical examinations, including Kernig's, Brudzinski's, and nuchal rigidity signs, were attempted to determine the clinical course of PVM with various success rates revealed. Some epidemiological correlates of PVM were adequately reviewed and presented in this report. They were seen depending mainly on the causative virus. The abnormal cytological and biochemical features of PVM were also discussed and showed potentials to distinguish PVM from pediatric bacterial meningitis (PBM). The pathological, developmental, behavioral, and neuropsychological complications of PVM were also presented. All the previously utilized techniques for the etiological diagnosis of PVM which include virology, serology, biochemistry, and radiology, were presented and discussed to determine their efficiencies and limitations. Finally, molecular testing, mainly PCR, was introduced and showed 100% sensitivity rates.

Molecular identification and clinical characteristics of mumps virus and human herpesviruses associated with aseptic meningitis in South of Iran

Viral infections are the major etiological agent of aseptic meningitis; though, limited data exist on the prevalence and molecular epidemiology of viral pathogens responsible for the occurrence of aseptic meningitis in Iran. Therefore, this study aimed to elucidate the prevalence and clinical features of mumps virus and human herpesviruses associated with aseptic meningitis in the South of Iran. A total of 73 patients with aseptic meningitis were enrolled in this study. Cerebral spinal fluid (CSF) samples were tested for detection of HSV, CMV, VZV and mumps virus using nested PCR assay. Mumps virus, HSV-1 and VZV were found in 4 (5.5%), 4 (5.5%) and 3 (4.1%) of the CSF samples, respectively. The highest rates of mumps virus and HSV infections were observed in infants less than one year, and VZV was more prevalent in patients under 5 years of age. The majority of mumps virus and VZV infections were found among male patients, while HSV was more prevalent among female patients. The highest incidence of aseptic meningitis associated with mumps virus was observed in summer, while HSV and VZV were more prevalent during spring. Headache was the most common symptom in mumps meningitis. About HSV and VZV, the most predominant clinical symptom was fever. The results of this study indicate the importance of molecular assay in the diagnosis of etiological agents of aseptic meningitis. Prompt detection of viral pathogens provides a better chance of managing viral meningitis in health care settings.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13337-021-00718-y.

Viral Etiologies of Meningitis in Patients with Presumed Pyogenic Meningitis at University Hospitals in Ethiopia

Introduction

Viral meningitis is common in most resource-limited settings, posing a challenge for the management and prognosis of suspected patients. No study has been done on the detection of either viral or viral-bacterial co-infection among presumed pyogenic meningitis cases in Ethiopia. We, therefore, aimed to determine the distribution of cytomegalovirus (CMV) and human enteroviruses (HEVs) among patients with presumptive pyogenic meningitis at University hospitals in Ethiopia.

Methods

Viral nucleic acid was extracted from 86 repository CSF samples, which were collected from patients presumptively diagnosed with pyogenic meningitis between 2012 and 2013. PCR was done consecutively to investigate the possible viral etiologic agents of meningitis.

Results

HEVs were detected in 11 (12.8%) of the analyzed samples while none of the 86 samples were tested positive for CMV. Viral-bacterial co-infections were found among 4/11 (36.4%) confirmed cases. The majority of the patients (10/11) with HEVs were younger aged ≤ 19 years old.

Conclusions

In this study, the magnitude of HEVs was shown to have a significant role in presumed pyogenic meningitis cases. Therefore, we recommend presumed pyogenic meningitis cases to be inspected for viral etiologies and improve meningeal symptoms interpretations.

Epidemiology of herpes simplex and varicella zoster virus in cerebrospinal fluid of patients suffering from meningitis in Iran

From the early 18th century that “meningitis” outbreak was firstly recorded in Geneva, it is one of the alarming health problems worldwide. Different infectious risk factors may contribute to the progression of meningitis. Herpes simplex virus (HSV) and Varicella-zoster virus (VZV) are just some noticeable risk factors among many involved in the progression of this disease. In this study, 415 meningitis suspected patients were recruited with some symptoms, such as fever, headache, nausea or vomiting, seizure, rash, dizziness from four different hospitals of Iran and molecular examinations of samples were performed by using specific primers of HSV½ and VZV via real-time PCR. Out of 415 included patient 41 (9.8 %) were VZV and six (1.4 %) cases were HSV ½ positive. Fever was the most frequent symptom by 315 (76 %) of patients with median temperature of 38 °C in all included patients. The median WBS counts of CSF in VZV positive, HSV½ positive, and all included cases were 1567 × 10⁶ /L, 1257 × 10⁶ /L, and 766 × 10⁶ /L (range 0-21200), respectively. In conclusion, as the rate of VZV infection was high among children patients and it was associated with the absence of vaccination program for chickenpox in Iran, we suggested that VZV is one of the plausible hallmarks in meningitis.

Immune response of T cells during herpes simplex virus type 1 (HSV-1) infection

Herpes simplex virus type 1 (HSV-1), a neurotropic member of the alphaherpes virus family, is among the most prevalent and successful human pathogens. HSV-1 can cause serious diseases at every stage of life including fatal disseminated disease in newborns, cold sores, eye disease, and fatal encephalitis in adults. HSV-1 infection can trigger rapid immune responses, and efficient inhibition and clearance of HSV-1 infection rely on both the innate and adaptive immune responses of the host. Multiple strategies have been used to restrict host innate immune responses by HSV-1 to facilitate its infection in host cells. The adaptive immunity of the host plays an important role in inhibiting HSV-1 infections. The activation and regulation of T cells are the important aspects of the adaptive immunity. They play a crucial role in host-mediated immunity and are important for clearing HSV-1. In this review, we examine the findings on T cell immune responses during HSV-1 infection, which hold promise in the design of new vaccine candidates for HSV-1.

The prevalence of herpes simplex virus type 1 and 2 infection in Iran: A meta-analysis

BACKGROUND

Seroepidemiologic studies indicate a high prevalence of herpes simplex virus (HSV) infection. This infection leads to ophthalmic, dermatologic, oral, neurologic, vaginal and cervical problems. Different studies have been carried out to estimate the HSV seroprevalence in Iran. Combining the results of these studies would be useful for health policy-making.

OBJECTIVE

This study aims to estimate the pooled prevalence of HSV infection using meta-analysis.

MATERIALS AND METHODS

Using relevant keywords, national and international data banks were searched. Restricting the search strategy, excluding duplicates and investigating the titles and abstracts, relevant articles were identified. To increase the search sensitivity, the lists of references were investigated. To find un-published studies, specialized experts as well as research centers were interviewed. The heterogeneity between the results was assessed using Cochrane test and I-squared indicator. The pooled prevalence of HSV infection was estimated using random effects model.

RESULTS

We recruited 33 eligible papers investigated 7762 individuals. The total prevalences (95% confidence intervals) of HSV1, HSV2 and HSV infections were estimated as of 42.04% (20.9-63.1), 6.5% (4.7-8.2) and 25.7% (8.8-42.5) respectively.

CONCLUSION

This meta-analysis showed that the HSV2 seroprevalence among Iranian people is considerably lower than HSV1 infection.

Impact of Human Enterovirus 71 Genotypes in Meningoencephalitis in Iran

Background:

Since the importance of poliovirus has diminished, as a result of its elimination in the majority of countries, non-polioviruses are emerging as causative agents of severe central nervous system (CNS) involvement. Outbreaks of enterovirus 71 (EV71)-associated CNS infections have recently been reported in Asia, Australia, and Europe.

Objectives:

This is the first study on genotyping of EV71 in children with meningoencephalitis to be carried out in Iran, and it was conducted in order to obtain an improved understanding of the disease burden of this virus, particularly with regard to CNS involvement.

Patients and Methods:

Viral RNA was extracted from 170 cerebrospinal fluid samples obtained from children aged under 8 years with a primary diagnosis of aseptic meningitis. Specific EV71 PCR was conducted to identify the genotype of the detected EV71 viruses.

Results:

Human enteroviruses (HEVs) were detected in 89 patients (52.3%). EV71 infection was detected in 19 (21.3%) of the 89 EV71-positive patients, and the C genotype was identified in 15 isolates.

Conclusions:

The C genotype should be considered as the prevalent EV71 circulating genotype in Iran, particularly in cases of aseptic meningitis.