Key result
Enterovirus was detected in 5.5% of cerebrospinal fluid samples from undiagnosed central nervous system infections, while rotavirus, norovirus, and human astrovirus were not detected.
Why the study?
Gastroenteric viruses have recently been linked to central nervous system disorders alongside enteroviruses, prompting investigation into their presence and molecular characteristics in undiagnosed CNS infections.
Observational (n=288)
No
Enteroviruses, including rare genotypes like E3 and CVA6, are present in a small but significant proportion of undiagnosed CNS infections in Brazil, highlighting the need for active viral surveillance.
Supports enterovirus testing in undiagnosed CNS infections; leaves open etiologic roles of other viruses pending prospective studies.
Enterovirus (EV) is commonly associated with central nervous system (CNS) syndromes. Recently, gastroenteric viruses, including rotavirus (RVA), human astrovirus (HAstV), and norovirus (NoV), have also been associated with CNS neurological disorders. The aim of the present study was to investigate the presence of EV, RVA, HAst, and NoV associated to CNS infections with undiagnosed etiology in Northwest region of São Paulo State, Brazil, and to conduct the molecular characterization of the positive samples detected. A total of 288 cerebrospinal fluid samples collected from July to December 2017 were tested for EV and NoV by quantitative real-time polymerase chain reaction (RT-qPCR), HAstV by conventional RT-PCR, and RVA by enzyme-linked immunosorbent assay. Positive-EV samples were inoculated in cells lines, amplified by RT-PCR and sequenced. RVA, NoV, and HAstV were not detected. EV infection was detected in 5.5% (16/288), and five samples successful genotyped: echovirus 3 (E3) (1/5), coxsackie virus A6 (CVA6) (1/5), and coxsackie virus B4 (CVB4) (3/5). Meningitis was the main syndrome observed (12/16; 75%). CVA6, CVB4, and E3 were identified associated with aseptic meningitis. Reports of CVA6 associated with aseptic meningitis are rare, E3 had not been previously reported in Brazil, and epidemiological data on CVB4 in the country is virtually unknown. The present investigation illustrates the circulation of diverse EV types in a small regional sample set and in a short period of time, highlighting the importance of an active EV surveillance system in CNS infections. Enhanced understanding of undiagnosed CNS infections will assist in public health and health care planning.
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Rocha et al. (2020) conducted an observational in Central nervous system infections with undiagnosed etiology (n=288). Enteric viruses was evaluated on Detection of enteric viruses in cerebrospinal fluid. Enterovirus was detected in 5.5% of cerebrospinal fluid samples from undiagnosed central nervous system infections, while rotavirus, norovirus, and human astrovirus were not detected.
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