title: Viral infections of the central nervous system in Spain: a prospective study.
abstract: The aim of the study was to determine the incidence of viruses causing aseptic meningitis, meningoencephalitis, and encephalitis in Spain. This was a prospective study, in collaboration with 17 Spanish hospitals, including 581 cases (CSF from all and sera from 280): meningitis (340), meningoencephalitis (91), encephalitis (76), febrile syndrome (7), other neurological disorders (32), and 35 cases without clinical information. CSF were assayed by PCR for enterovirus (EV), herpesvirus (herpes simplex [HSV], varicella-zoster [VZV], cytomegalovirus [CMV], Epstein-Barr [EBV], and human herpes virus-6 [HHV-6]), mumps (MV), Toscana virus (TOSV), adenovirus (HAdV), lymphocytic choriomeningitis virus (LCMV), West Nile virus (WNV), and rabies. Serology was undertaken when methodology was available. Amongst meningitis cases, 57.1% were characterized; EV was the most frequent (76.8%), followed by VZV (10.3%) and HSV (3.1%; HSV-1: 1.6%; HSV-2: 1.0%, HSV non-typed: 0.5%). Cases due to CMV, EBV, HHV-6, MV, TOSV, HAdV, and LCMV were also detected. For meningoencephalitis, 40.7% of cases were diagnosed, HSV-1 (43.2%) and VZV (27.0%) being the most frequent agents, while cases associated with HSV-2, EV, CMV, MV, and LCMV were also detected. For encephalitis, 27.6% of cases were caused by HSV-1 (71.4%), VZV (19.1%), or EV (9.5%). Other positive neurological syndromes included cerebellitis (EV and HAdV), seizures (HSV), demyelinating disease (HSV-1 and HHV-6), myelopathy (VZV), and polyradiculoneuritis (HSV). No rabies or WNV cases were identified. EVs are the most frequent cause of meningitis, as is HSV for meningoencephalitis and encephalitis. A significant number of cases (42.9% meningitis, 59.3% meningoencephalitis, 72.4% encephalitis) still have no etiological diagnosis.
authors.affiliation: National Centre for Microbiology, Majadahonda, Spain. fory@isciii.es
authors.forename: F
authors.initials: F
authors.lastname: de Ory
authors.forename: A
authors.initials: A
authors.lastname: Avellón
authors.forename: J E
authors.initials: JE
authors.lastname: Echevarría
authors.forename: M P
authors.initials: MP
authors.lastname: Sánchez-Seco
authors.forename: G
authors.initials: G
authors.lastname: Trallero
authors.forename: M
authors.initials: M
authors.lastname: Cabrerizo
authors.forename: I
authors.initials: I
authors.lastname: Casas
authors.forename: F
authors.initials: F
authors.lastname: Pozo
authors.forename: G
authors.initials: G
authors.lastname: Fedele
authors.forename: D
authors.initials: D
authors.lastname: Vicente
authors.forename: M J
authors.initials: MJ
authors.lastname: Pena
authors.forename: A
authors.initials: A
authors.lastname: Moreno
authors.forename: J
authors.initials: J
authors.lastname: Niubo
authors.forename: N
authors.initials: N
authors.lastname: Rabella
authors.forename: G
authors.initials: G
authors.lastname: Rubio
authors.forename: M
authors.initials: M
authors.lastname: Pérez-Ruiz
authors.forename: M
authors.initials: M
authors.lastname: Rodríguez-Iglesias
authors.forename: C
authors.initials: C
authors.lastname: Gimeno
authors.forename: J M
authors.initials: JM
authors.lastname: Eiros
authors.forename: S
authors.initials: S
authors.lastname: Melón
authors.forename: M
authors.initials: M
authors.lastname: Blasco
authors.forename: I
authors.initials: I
authors.lastname: López-Miragaya
authors.forename: E
authors.initials: E
authors.lastname: Varela
authors.forename: A
authors.initials: A
authors.lastname: Martinez-Sapiña
authors.forename: G
authors.initials: G
authors.lastname: Rodríguez
authors.forename: M Á
authors.initials: MÁ
authors.lastname: Marcos
authors.forename: M I
authors.initials: MI
authors.lastname: Gegúndez
authors.forename: G
authors.initials: G
authors.lastname: Cilla
authors.forename: I
authors.initials: I
authors.lastname: Gabilondo
authors.forename: J M
authors.initials: JM
authors.lastname: Navarro
authors.forename: J
authors.initials: J
authors.lastname: Torres
authors.forename: C
authors.initials: C
authors.lastname: Aznar
authors.forename: A
authors.initials: A
authors.lastname: Castellanos
authors.forename: M E
authors.initials: ME
authors.lastname: Guisasola
authors.forename: A I
authors.initials: AI
authors.lastname: Negredo
authors.forename: A
authors.initials: A
authors.lastname: Tenorio
authors.forename: S
authors.initials: S
authors.lastname: Vázquez-Morón
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002494:Central Nervous System Infections / Q000453:epidemiology* / Q000821:virology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D014777:Virus Diseases / Q000453:epidemiology* / Q000821:virology*; D014780:Viruses / Q000145:classification / Q000302:isolation & purification*; D055815:Young Adult