Role of Viral Agents in Childhood Central Nervous System Infections

Rapid laboratory diagnosis in acute viral infections in the central nervous system (CNS) is important for the direction of treatment. In this study, we aimed to evaluate viral agents detected by real-time polymerase chain reaction (PCR) in cerebrospinal fluid (CSF) samples sent to the national virology reference laboratory for the diagnosis of acute CNS viral infection in the 0 to 18 age group. The results of 5,255 CSF samples submitted to the laboratory between January 1, 2009, and February 14, 2018, were retrospectively reviewed. Test results of CSF samples tested with the multiplex real-time PCR panel (Fast Track Diagnostics/Viral Meningitis commercial kit, Luxembourg) kit were evaluated. PCR positivity was detected in 216 (4.11%) of the 5,255 CSF samples tested. The most common agents were enteroviruses 92 (42.6%) and herpes simplex virus-1 (HSV-1) 87 (40.2%) while varicella-zoster virus (VZV) 24 (11.1%), mumps virus 10 (4.62%), parechovirus 2 (0.92%), and herpes simplex virus-2 (HSV-2) 1 (0.46%) were less often identified. Considering the possibility that a wide variety of microorganisms may be agents of CNS infections, the performing of routine laboratory tests with multiple, fast, and reliable nucleic acid tests such as multiplex PCR provides a practical and effective approach. In addition to the identification of agents, retrospective studies of the incidence of agents will shed light on the clinical approaches in terms of the agents to be considered in the preliminary diagnosis. We consider that our results are valuable in terms of the high number of samples examined by the national virology reference laboratory over a 9-year period, and will contribute to clinicians' understanding of the epidemiology of meningitis in our country, and assist in identifying when and how to investigate patients for possible meningitis.