title: Etiologic agents of central nervous system infections among febrile hospitalized patients in the country of Georgia.
abstract: OBJECTIVE
  There is a large spectrum of viral, bacterial, fungal, and prion pathogens that cause central nervous system (CNS) infections. As such, identification of the etiological agent requires multiple laboratory tests and accurate diagnosis requires clinical and epidemiological information. This hospital-based study aimed to determine the main causes of acute meningitis and encephalitis and enhance laboratory capacity for CNS infection diagnosis.
  
  
  METHODS
  Children and adults patients clinically diagnosed with meningitis or encephalitis were enrolled at four reference health centers. Cerebrospinal fluid (CSF) was collected for bacterial culture, and in-house and multiplex RT-PCR testing was conducted for herpes simplex virus (HSV) types 1 and 2, mumps virus, enterovirus, varicella zoster virus (VZV), Streptococcus pneumoniae, HiB and Neisseria meningitidis.
  
  
  RESULTS
  Out of 140 enrolled patients, the mean age was 23.9 years, and 58% were children. Bacterial or viral etiologies were determined in 51% of patients. Five Streptococcus pneumoniae cultures were isolated from CSF. Based on in-house PCR analysis, 25 patients were positive for S. pneumoniae, 6 for N. meningitidis, and 1 for H. influenzae. Viral multiplex PCR identified infections with enterovirus (n = 26), VZV (n = 4), and HSV-1 (n = 2). No patient was positive for mumps or HSV-2.
  
  
  CONCLUSIONS
  Study findings indicate that S. pneumoniae and enteroviruses are the main etiologies in this patient cohort. The utility of molecular diagnostics for pathogen identification combined with the knowledge provided by the investigation may improve health outcomes of CNS infection cases in Georgia.
authors.affiliation: I. Javakhishvili Tbilisi State University, Department of Neurology and Neurosurgery, Tbilisi, Georgia; US Army Medical Research Unit-Georgia (USAMRU-G), Tbilisi, Georgia.
authors.forename: Tamar
authors.initials: T
authors.lastname: Akhvlediani
authors.affiliation: Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America.
authors.forename: Christian T
authors.initials: CT
authors.lastname: Bautista
authors.affiliation: P. Sarajishvili Institute of Clinical Neurology and Neurosurgery, Tbilisi, Georgia.
authors.forename: Roman
authors.initials: R
authors.lastname: Shakarishvili
authors.affiliation: Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia.
authors.forename: Tengiz
authors.initials: T
authors.lastname: Tsertsvadze
authors.affiliation: National Center for Disease Control and Public Health, Tbilisi, Georgia.
authors.forename: Paata
authors.initials: P
authors.lastname: Imnadze
authors.affiliation: Neurology Department of the Iashvili Children's Hospital, Tbilisi, Georgia.
authors.forename: Nana
authors.initials: N
authors.lastname: Tatishvili
authors.affiliation: Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia.
authors.forename: Tamar
authors.initials: T
authors.lastname: Davitashvili
authors.affiliation: Neurology Department of the Iashvili Children's Hospital, Tbilisi, Georgia.
authors.forename: Tamar
authors.initials: T
authors.lastname: Samkharadze
authors.affiliation: National Center for Disease Control and Public Health, Tbilisi, Georgia.
authors.forename: Rusudan
authors.initials: R
authors.lastname: Chlikadze
authors.affiliation: Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia.
authors.forename: Natia
authors.initials: N
authors.lastname: Dvali
authors.affiliation: Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia.
authors.forename: Lela
authors.initials: L
authors.lastname: Dzigua
authors.affiliation: Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia.
authors.forename: Mariam
authors.initials: M
authors.lastname: Karchava
authors.affiliation: Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia.
authors.forename: Lana
authors.initials: L
authors.lastname: Gatserelia
authors.affiliation: Scientific Research Center of Infectious Pathology, AIDS, and Clinical Immunology, Tbilisi, Georgia.
authors.forename: Nino
authors.initials: N
authors.lastname: Macharashvili
authors.affiliation: P. Sarajishvili Institute of Clinical Neurology and Neurosurgery, Tbilisi, Georgia.
authors.forename: Nana
authors.initials: N
authors.lastname: Kvirkvelia
authors.affiliation: Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt.
authors.forename: Engy Emil
authors.initials: EE
authors.lastname: Habashy
authors.affiliation: Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt.
authors.forename: Margaret
authors.initials: M
authors.lastname: Farrell
authors.affiliation: Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt.
authors.forename: Emily
authors.initials: E
authors.lastname: Rowlinson
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: James
authors.initials: J
authors.lastname: Sejvar
authors.affiliation: US Army Medical Research Institute of Infectious Diseases, Frederick, Maryland, United States of America.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hepburn
authors.affiliation: Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Pimentel
authors.affiliation: Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt; National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Erica
authors.initials: E
authors.lastname: Dueger
authors.affiliation: Global Disease Detection and Response Program, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt.
authors.forename: Brent
authors.initials: B
authors.lastname: House
authors.affiliation: US Army Medical Research Institute of Infectious Diseases, Frederick, Maryland, United States of America.
authors.forename: Robert
authors.initials: R
authors.lastname: Rivard
mesh_terms: D000293:Adolescent; D000328:Adult; D002555:Cerebrospinal Fluid / Q000382:microbiology / Q000821:virology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004269:DNA, Bacterial / Q000032:analysis; D004279:DNA, Viral / Q000032:analysis; D004660:Encephalitis / Q000175:diagnosis* / Q000382:microbiology / Q000821:virology; D004770:Enterovirus / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D005846:Georgia (Republic); D006193:Haemophilus influenzae / Q000235:genetics / Q000302:isolation & purification; D018259:Herpesvirus 1, Human / Q000235:genetics / Q000302:isolation & purification; D018258:Herpesvirus 2, Human / Q000235:genetics / Q000302:isolation & purification; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000302:isolation & purification; D006760:Hospitalization; D006801:Humans; D008297:Male; D008581:Meningitis / Q000175:diagnosis* / Q000382:microbiology / Q000821:virology; D060885:Multiplex Polymerase Chain Reaction; D009345:Neisseria meningitidis / Q000235:genetics / Q000302:isolation & purification; D010361:Patients; D013296:Streptococcus pneumoniae / Q000235:genetics / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D004269:DNA, Bacterial; D004279:DNA, Viral