title: Enteroviral central nervous system infections in children of the region of monastir, Tunisia: diagnosis, laboratory findings of cerebrospinal fluid and clinical manifestations.
abstract: Human enteroviruses (HEV) are one of the major causes of central nervous system (CNS) infections in pediatrics. A prospective study was conducted to assess the epidemiological, clinical, and laboratory characteristics of enterovirus (EV) infections of the CNS in children under 15-years-old, suspected of having viral CNS infections and admitted to the Pediatric Department of Monastir University Hospital, Tunisia. Enteroviral RNA was detected by 5' NCR nested RT-PCR assay in 33 % (20 out of 60) of cerebrospinal fluid specimens, whereas only six samples (10 %) were EV positive in cell culture. EV-positive patients were clustered according to their clinical manifestations, predominantly diagnosed as aseptic meningitis (65 %) and meningoencephalitis (20 %). Fever, headache, vomiting, and neck stiffness were the most pronounced symptoms. Pleocytosis with the predominance of lymphocytes was observed in 60 % of EV positive specimens. Although patients suffering from EV infections were encountered throughout the year, most occurred during spring and summer months. Using VP1-2A nested RT-PCR and sequence analysis, three of the 20 positive HEV were identified as Echovirus (E)-9. This is the first report of a cluster of aseptic meningitis cases caused by E-9 in Monastir.
authors.affiliation: Laboratory of Infectious Diseases and Biological Agents LR99-ES27, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia.
authors.forename: Raida
authors.initials: R
authors.lastname: El Hiar
authors.forename: Samir
authors.initials: S
authors.lastname: Haddad
authors.forename: Hela
authors.initials: H
authors.lastname: Jaïdane
authors.forename: Didier
authors.initials: D
authors.lastname: Hober
authors.forename: Manel
authors.initials: M
authors.lastname: Ben M'hadheb-Gharbi
authors.forename: Maria
authors.initials: M
authors.lastname: Gullberg
authors.forename: Mohamed
authors.initials: M
authors.lastname: Neji-Guediche
authors.forename: A Michael
authors.initials: AM
authors.lastname: Lindberg
authors.forename: Jawhar
authors.initials: J
authors.lastname: Gharbi
authors.forename: Mahjoub
authors.initials: M
authors.lastname: Aouni
keywords: Cerebrospinal fluid; Children; Enterovirus; Epidemiology; Molecular typing