Etiology of Central Nervous System Infections in a Rural Area of Nepal Using Molecular Approaches
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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.
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Frequent HHV-6 and Cytomegalovirus detection by FA-ME is reported by several authors, who in most cases considered them non-pathogenic due to latency capacity and chromosomal integration (HHV-6), and non-significance in immunocompetent patients (Cytomegalovirus).
“Frequent HHV-6 and Cytomegalovirus detection by FA-ME is reported by several authors, who in most cases considered them non-pathogenic due to their latency capacity and chromosomal integration (HHV-6), and non-significance in immunocompetent patients (Cytomegalovirus) [17, 20, 31, 34–36].”
From Clinical utility of the FilmArray® meningitis/encephalitis panel in children with suspected central nervous system infection in a low-resource setting – a prospective study in Southwestern Uganda (2025) · cites this paper as [35]
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- Authors
- Säll, O., Thulin Hedberg, S., Neander, M., Tiwari, S., Dornon, L., Bom, R., Lagerqvist, N., Sundqvist, M., & Mölling, P.
- Affiliations
- Örebro University (SE)
- Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden;
- United Mission Hospital Tansen, Tansen, Nepal;
- Public Health Agency of Sweden (SE)
- Corresponding author
- Säll, Olof
- Venue
- The American Journal of Tropical Medicine and Hygiene
- Published
- 2019-07-03
- Volume
- 101
- Issue
- 1
- Pages
- 253-259
- ISSN
- 0002-9637 (ISSN-L)
- 1476-1645
- PMC
- PMC6609203
- OpenAlex
- W2948177665
- Cited by
- 20
- References
- 37
- Citations by year
- 2025: 2 · 2024: 3 · 2023: 6 · 2022: 4 · 2020: 2 · 2019: 2 · 2018: 1
- FWCI
- 1.53
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Tropical Medicine and Hygiene (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Public Health Agency
- Örebro Universitet
- Svenska Läkaresällskapet
- Region Örebro län
- Folkhälsomyndigheten
- Faculty of Medicine and Health, University of Sydney
- Topics
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Mosquito-borne diseases and control
- Keywords
- central nervous system infection, cerebrospinal fluid, molecular diagnosis, pathogen detection, enterovirus, herpesvirus, cytomegalovirus, Cryptococcus neoformans, Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitidis, antibiotic exposure, rural Nepal
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Bacterial Infections, Child, Child, Preschool, Cryptococcosis, Cryptococcus neoformans, Female, Humans, Infant, Male, Middle Aged, Nepal, Rural Population, Virus Diseases, Cryopreservation, Polymerase Chain Reaction, Young Adult
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