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Enteroviral Central Nervous System Infections in Children of the Region of Monastir, Tunisia: Diagnosis, Laboratory Findings of Cerebrospinal Fluid and Clinical Manifestations

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Abstract

Human enteroviruses (HEV) are one of the major causes of central nervous system (CNS) infections in pediatrics. A prospective study was conducted to assess the epidemiological, clinical, and laboratory characteristics of enterovirus (EV) infections of the CNS in children under 15-years-old, suspected of having viral CNS infections and admitted to the Pediatric Department of Monastir University Hospital, Tunisia. Enteroviral RNA was detected by 5′ NCR nested RT-PCR assay in 33 % (20 out of 60) of cerebrospinal fluid specimens, whereas only six samples (10 %) were EV positive in cell culture. EV-positive patients were clustered according to their clinical manifestations, predominantly diagnosed as aseptic meningitis (65 %) and meningoencephalitis (20 %). Fever, headache, vomiting, and neck stiffness were the most pronounced symptoms. Pleocytosis with the predominance of lymphocytes was observed in 60 % of EV positive specimens. Although patients suffering from EV infections were encountered throughout the year, most occurred during spring and summer months. Using VP1-2A nested RT-PCR and sequence analysis, three of the 20 positive HEV were identified as Echovirus (E)-9. This is the first report of a cluster of aseptic meningitis cases caused by E-9 in Monastir.

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Acknowledgments

This work was supported by the Ministère de l’Enseignement Supérieur et de la Recherche Scientifique (LR 99 ES 27), University of Monastir, Tunisia. We want to express our gratitude to the staff of the Pediatrics Department of Fattouma Bourguiba Hospital of Monastir. The authors are grateful to Rachel Décor (B.C.T. Consulting, Rue du 13 Août 1956, 5000 Monastir, Tunisia) for the English revision of this manuscript.

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  1. Laboratory of Infectious Diseases and Biological Agents LR99-ES27, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia

    Raida EL Hiar, Hela Jaïdane, Manel Ben M’hadheb-Gharbi, Jawhar Gharbi & Mahjoub Aouni

  2. Pediatric Department, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia

    Samir Haddad & Mohamed Neji-Guediche

  3. Laboratory of Virology EA3610, Faculty of Medicine, CHRU Lille, University Lille 2, 59120, Loos-lez-Lille, France

    Didier Hober

  4. School of Natural Sciences, Linnaeus University, 391 82, Kalmar, Sweden

    Maria Gullberg & A. Michael Lindberg

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  1. Raida EL Hiar
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EL Hiar, R., Haddad, S., Jaïdane, H. et al. Enteroviral Central Nervous System Infections in Children of the Region of Monastir, Tunisia: Diagnosis, Laboratory Findings of Cerebrospinal Fluid and Clinical Manifestations. Indian J. Virol. 23, 294–302 (2012). https://doi.org/10.1007/s13337-012-0104-1

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