CLINICAL, BIOLOGICAL CHARACTERISTICS, RISK FACTORS AND OUTCOMES IN HUMAN ENTEROVIRUS CENTRAL NERVOUS SYSTEM INFECTIONS: A PROSPECTIVE STUDY PERFORMED IN A TERTIARY HOSPITAL

Authors

  • Georgiana ENACHE-LEONTE “Sf. Parascheva” Clinical Hospital of Infectious Diseases Iasi
  • Raluca Erika IRIMIE-BALUTA “Sf. Parascheva” Clinical Hospital of Infectious Diseases Iasi
  • M. E. HURMUZACHE “Sf. Parascheva” Clinical Hospital of Infectious Diseases Iasi
  • Ioana ONOFREI “Sf. Parascheva” Clinical Hospital of Infectious Diseases Iasi
  • Catalina Mihaela LUCA “Sf. Parascheva” Clinical Hospital of Infectious Diseases Iasi

Abstract

Human enterovirus (HEV) infection is transmitted mainly by the fecal-oral route and has mostly a subclinical, self - limited evolution. This viral central nervous system (CNS)infection could be fatal in various categories of patients. The aim of the current study was to evaluate the clinical-biological characteristics and outcomes of HEV CNS infections in patients admitted to the “Sf. Parascheva” Clinical Hospital of Infectious Diseases Iasi, during 2018-2019. Materials and methods: We performed an observational prospective study in patients with confirmed HEV CNS infections (encephalitis / meningitis) by cerebrospinal fluid analysis. Clinical and laboratory data were collected from medical records. Results: Sixty - four patients were included, of which 57.81% were diagnosed with HEV encephalitis. All categories of ages were affected, with a median of 67 years in encephalitis and 56 years for patients with meningitis. The most frequent comorbidities were cardiovascular (44.29% cases). The blood neutrophil - lymphocytes ratio (NLR) was statistically significant higher in case of HEV meningitis compared to encephalitis (12.42 ± 4.12 vs. 7.97 ± 3.86, p = 0.04). There were significant differences regarding NLR measured in cerebrospinal fluid. The median duration of hospitalization was 5.63 days in HEV encephalitis and 10.92 days in HEV meningitis. There were recorded 23.33% cases of death, all in old, immunosuppressed patients (diabetic patients) with HEV encephalitis. Conclusions: HEV CNS infections, are an important cause of mortality in high - risk patients (elderly, immunosuppression). Measurement of NLR could be a useful early diagnostic tool to ensure proper pharmacological management of HEV infections. 

Author Biographies

  • M. E. HURMUZACHE, “Sf. Parascheva” Clinical Hospital of Infectious Diseases Iasi

    “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Romania
    Faculty of Medicine

  • Ioana ONOFREI, “Sf. Parascheva” Clinical Hospital of Infectious Diseases Iasi

    Grigore T. Popa” University of Medicine and Pharmacy Iasi, Romania
    Faculty of Medicine

  • Catalina Mihaela LUCA, “Sf. Parascheva” Clinical Hospital of Infectious Diseases Iasi

    Grigore T. Popa” University of Medicine and Pharmacy Iasi, Romania
    Faculty of Medicine

References

1. Costa BKD, Sato DK. Viral encephalitis: a practical review on diagnostic approach and treatment. J Pediatr (Rio J) 2020; 96: 12-19.

2. Xu H, Chen P, Guo S, et al. Progress in etiological diagnosis of viral meningitis. Front Neurol 2023; 14: 1193834.

3. Islam MA, Cavestro C, Alam SS, et al. Encephalitis in Patients with COVID-19: A Systematic Evi-dence-Based Analysis. Cells 2022; 11(16): 2575.

4. Venkatesan A, Tunkel AR, Bloch KC, et al. International Encephalitis Consortium. Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis consortium. Clin Infect Dis. 2013; 57(8): 1114-1128.

5. Staal SL, Olie SE; I-PACE study group; et al. Validation of the encephalitis criteria in adults with a suspected central nervous system infection: An updated score. J Infect 2024; 89(4): 106239.

6. Patel S, Jhala P, Sharma H. A Study of the Etiology, Clinical Profile, and Diagnosis of Various Types of Central Nervous System Infections in a Tertiary Care Center. Cureus 2024; 16(2): e54250.

7. Garber B, Glauser J. Viral Meningitis and Encephalitis Update. Curr Emerg Hosp Med Rep 2024; 12: 95-102.

8. Tunkel AR, Glaser CA, Bloch KC, et al. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2008; 47(3): 303-327.

9. Feng G, Zhou L, Li F, et al. Predictors of Outcome in Clinically Diagnosed Viral Encephalitis Patients: A 5-Year Prospective Study. Biomed Res In 2020; 2020: 2832418.

10. Petersen PT, Bodilsen J, Jepsen MPG, et al. Clinical features and prognostic factors in adults with viral meningitis. Brain 2023; 146(9): 3816-3825.

11. Buonacera A, Stancanelli B, Colaci M, et al. Neutrophil to Lymphocyte Ratio: An Emerging Marker of the Relationships between the Immune System and Diseases. Int J Mol Sci 2022; 23(7): 3636.

12. Kim JH, Kim HJ, Na JU, et al. Hematologic parameters to predict negative cerebrospinal fluid exam-ination results among neurologically intact patients who underwent lumbar puncture on suspicion of central nervous system infection. Clin Exp Emerg Med 2017; 4(1): 25-31.

13. Lo YT, Lim VY, Ng M, et al. A Prognostic Model Using Post-Steroid Neutrophil-Lymphocyte Ratio Predicts Overall Survival in Primary Central Nervous System Lymphoma. Cancers (Basel) 2022; 14(7): 1818.

14. Widjaja H, Rusmawatiningtyas D, Makrufardi F, et al. Neutrophil lymphocyte ratio as predictor of mortality in pediatric patients with bacterial meningitis: A retrospective cohort study. Ann Med Surg (London) 2021; 73: 103191.

15. Nugrahanto AP, Triono A, Damroni RA, et al. Diagnostic Value of Serum Procalcitonin, CSF Neu-trophil-to-lymphocyte Ratio, and CSF Lactate in Pediatric Bacterial Meningoencephalitis. Ann Indian Acad Neurol 2024; 27(4): 371-377.

16. Studahl M, Lindquist L, Eriksson BM, et al. Acute viral infections of the central nervous system in immunocompetent adults: diagnosis and management. Drugs 2013; 73(2): 131-58.

17. Ben Abid F, Abukhattab M, Ghazouani H, et al. Epidemiology and clinical outcomes of viral central nervous system infections. Int J Infect Dis 2018; 73: 85-90.

Additional Files

Published

2024-12-23

Issue

Section

INTERNAL MEDICINE - PEDIATRICS