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. 2017 Dec 29;17(1):806.
doi: 10.1186/s12879-017-2915-6.

The aetiologies of central nervous system infections in hospitalised Cambodian children

Paul Turner  1   2   3 , Kuong Suy  4 , Le Van Tan  5 , Pora Sar  4 , Thyl Miliya  4 , Nguyen Thi Thu Hong  5 , Vu Thi Ty Hang  5 , Nguyen Thi Han Ny  5 , Sona Soeng  4 , Nicholas P J Day  6   7 , H Rogier van Doorn  7   5 , Claudia Turner  4   6   7
Affiliations

The aetiologies of central nervous system infections in hospitalised Cambodian children

Paul Turner et al. BMC Infect Dis. .

Abstract

Background: Central nervous system (CNS) infections are an important cause of childhood morbidity and mortality. The aetiologies of these potentially vaccine-preventable infections have not been well established in Cambodia.

Methods: We did a one year prospective study of children hospitalised with suspected CNS infection at Angkor Hospital for Children, Siem Reap. Cerebrospinal fluid specimens (CSF) samples underwent culture, multiplex PCR and serological analysis to identify a range of bacterial and viral pathogens. Viral metagenomics was performed on a subset of pathogen negative specimens.

Results: Between 1st October 2014 and 30th September 2015, 284 analysable patients were enrolled. The median patient age was 2.6 years; 62.0% were aged <5 years. CSF white blood cell count was ≥10 cells/μL in 116/272 (42.6%) cases. CNS infection was microbiologically confirmed in 55 children (19.3%). Enteroviruses (21/55), Japanese encephalitis virus (17/55), and Streptococcus pneumoniae (7/55) accounted for 45 (81.8%) of all pathogens identified. Of the pathogens detected, 74.5% (41/55) were viruses and 23.6% (13/55) were bacteria. The majority of patients were treated with ceftriaxone empirically. The case fatality rate was 2.5%.

Conclusions: Enteroviruses, JEV and S. pneumoniae are the most frequently detected causes of CNS infection in hospitalised Cambodian children.

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Conflict of interest statement

Ethics approval and consent to participate

Written informed consent was obtained from a child’s parent or guardian prior to study enrolment. The study protocol was reviewed and approved by the Angkor Hospital for Children Institutional Review Board (ref: 677/14) and the Oxford Tropical Ethics Committee (ref: 33-14).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study enrolment flowchart. *Including one culture-confirmed meningitis who did not fully meet the clinical case definition
Fig. 2
Fig. 2
Age distribution of 284 hospitalised children meeting the clinical case definition for CNS infection
Fig. 3
Fig. 3
Pathogen distribution by age group in 55 children with laboratory-confirmed CNS infection. EV: enterovirus; HSV: herpes simplex virus; JEV: Japanese encephalitis virus; MV: mumps virus; PV: parechovirus; VZV: varicella zoster virus
See this image and copyright information in PMC

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