title: Viral pathogens in children hospitalized with features of central nervous system infection in a malaria-endemic region of Papua New Guinea.
abstract: BACKGROUND
  Viral central nervous system (CNS) infections are common in countries where malaria is endemic but, due to limited laboratory facilities, few studies have systematically examined the prevalence and clinical consequences of the presence of viruses in cerebrospinal fluid (CSF) from children with suspected CNS infection.
  
  
  METHODS
  We performed a prospective study of Papua New Guinean children hospitalized with signs and symptoms of CNS infection. CSF samples from 300 children without proven bacterial/fungal meningitis were analyzed for human herpes viruses (HHV), picornaviruses, influenza, adenoviruses, flaviviruses and bacteria.
  
  
  RESULTS
  Fifty-five children (18%) had viral (42), bacterial (20) or both viral and bacterial (7) nucleic acids (NA) identified in their CSF. Human herpes viruses accounted for 91% of all viruses found. The identification of viral or bacterial NA was not associated with any characteristic clinical features. By contrast, malaria was associated with increased identification of viral and bacterial NA and with impaired consciousness, multiple convulsions and age. Malaria was also inversely associated with an adverse outcome. Amongst children with HHV infection, those with HHV-6 and -7 were younger, were more likely have impaired consciousness and had a higher proportion of adverse outcomes than children with CMV. Dengue and enteroviral infections were infrequent. Adenoviral and influenza infections were not identified.
  
  
  CONCLUSIONS
  Infections with HHV-6, HHV-7, dengue and enterovirus have the potential to cause serious CNS disease in young PNG children. However most HHVs in this malaria-endemic setting should be considered to be the result of reactivation from a latent reservoir without clinical sequelae.
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia. drmlaman@yahoo.com.|Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea. drmlaman@yahoo.com.
authors.forename: Moses
authors.initials: M
authors.lastname: Laman
authors.affiliation: Modilon General Hospital, Paediatrics department, Madang, Papua New Guinea. wohuierekei@hotmail.com.
authors.forename: Ilomo
authors.initials: I
authors.lastname: Hwaiwhanje
authors.affiliation: Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea. cathytiribona@gmail.com.
authors.forename: Cathy
authors.initials: C
authors.lastname: Bona
authors.affiliation: Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea. jonathan.warrel@pngimr.org.pg.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Warrel
authors.affiliation: Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea. susan.aipit@yahoo.com.
authors.forename: Susan
authors.initials: S
authors.lastname: Aipit
authors.affiliation: PathWest laboratory, School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, Western Australia, Australia. david.smith@health.wa.gov.au.
authors.forename: David
authors.initials: D
authors.lastname: Smith
authors.affiliation: PathWest laboratory, School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, Western Australia, Australia. Joanna.noronha@health.wa.gov.au.
authors.forename: Joanna
authors.initials: J
authors.lastname: Noronha
authors.affiliation: Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea. peter.siba@pngimr.org.pg.
authors.forename: Peter
authors.initials: P
authors.lastname: Siba
authors.affiliation: Barcelona Centre for International Health Research, (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain. ivomueller@fastmail.fm.|Walter & Eliza Hall Institute, Parkville, Victoria, Australia. ivomueller@fastmail.fm.
authors.forename: Ivo
authors.initials: I
authors.lastname: Mueller
authors.affiliation: Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea. ibetuela@gmail.com.
authors.forename: Inoni
authors.initials: I
authors.lastname: Betuela
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia. tim.davis@uwa.edu.au.
authors.forename: Timothy M E
authors.initials: TM
authors.lastname: Davis
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia. laurens.manning@uwa.edu.au.
authors.forename: Laurens
authors.initials: L
authors.lastname: Manning
mesh_terms: D020805:Central Nervous System Viral Diseases / Q000134:cerebrospinal fluid / Q000453:epidemiology* / Q000821:virology; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data; D002675:Child, Preschool; D004770:Enterovirus / Q000302:isolation & purification; D005260:Female; D015654:Herpesvirus 6, Human / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008288:Malaria / Q000150:complications / Q000453:epidemiology; D008297:Male; D010219:Papua New Guinea / Q000453:epidemiology; D010849:Picornaviridae / Q000302:isolation & purification; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies