ISSN: 2960-1959
Publisher
Original Articles

Viral Meningitis (Enterovirus) Outbreak in The Pediatric Population of Sulaymaniyah Governorate, Iraq: A Multi-Center Experience

Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
Research Center, University of Halabja, Halabja, Iraq
College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
Pediatric Teaching Hospital, Sulaymaniyah, Kurdistan, Iraq
Kalar General Hospital, Kalar, Sulaymaniyah, Kurdistan, Iraq
Faculty of Medical Sciences, School of Medicine, Department of Medical Microbiology, University of Sulaimani, Sulaymaniyah, Kurdistan, Iraq
Ministry of Health, Halabja Pediatric and Maternity Hospital, Halabja, Kurdistan, Iraq
Department of Medical Laboratory Science, College of Health Sciences, University of Human Development, Kurdistan, Sulaymaniyah, Iraq
Research Center, University of Halabja, Halabja, Kurdistan, Iraq
Halabja General Health Directorate, Ministry of Health, Halabja, Kurdistan, Iraq
Research Center, University of Halabja, Halabja, Kurdistan, Iraq

Abstract

Introduction

Viral meningitis, often caused by enteroviruses in children, is prevalent globally but is difficult to distinguish from bacterial forms. Molecular testing like PCR is vital; however. This study investigates the characteristics of viral meningitis in pediatric patients during an outbreak in   Sulaymaniyah Governorate, Iraq.

Methods

This is a multicentered prospective study that included children with a confirmed diagnosis of viral meningitis who have visited pediatric clinics throughout Sulaimani, Halabja, Kalar, and Ranya cities during the period from May 2023 to June 2023.

Results

In total, 116 cases were included, of whom 75 (64.7%) were male and had a mean age of 6.5 ± 3.2. Most were between the ages of 4-6 (38, 32.8%) and 7-12 years (55, 47.4%). Only 53.4% had contact with another patient. Common symptoms included fever (63.8%) and headache (62.1%). Lymphocyte predominance was observed in 46.6% of CSF samples. Upon molecular diagnosis, the inflammation in all of the cases was due to enterovirus infection. Most of the patients (75%) received empirical antibiotics. The average hospital stay was 10 days. While 95.7% of patients had no complications during recovery, a few experienced issues like weakness and malaise. All had good clinical outcomes.

Conclusion

The viral meningitis outbreak in Sulaymaniyah Governorate is caused by enterovirus, with epidemiological, clinical, and laboratory findings similar to that of the literature. The condition has resulted in a high prescription rate of empirical antibiotics due to late diagnosis.

References

  1. Liu H, Zhang H, Zhang M, Changzeng F, Cong S, Xu D, et al. Epidemiological and etiological characteristics of viral meningitis for hospitalized pediatric patients in Yunnan, China. Medicine. 2022;101(26);1-6. doi:10.1097/MD.0000000000029772
  2. Mount HR, Boyle SD. Aseptic and bacterial meningitis: evaluation, treatment, and prevention. American family physician. 2017;96(5):314-22. doi:N/A
  3. Alves FG, Wajnsztejn R, Alves CA, Morais TC, Fujimori M, Adami F, et al. Laboratory parameters of cerebrospinal fluid in individuals with enterovirus meningitis: a descriptive study. Journal of Human Growth and Development. 2015;25(2):237-42. doi:10.7322/jhgd.103022
  4. King RL, Lorch SA, Cohen DM, Hodinka RL, Cohn KA, Shah SS. Routine cerebrospinal fluid enterovirus polymerase chain reaction testing reduces hospitalization and antibiotic use for infants 90 days of age or younger. Pediatrics. 2007;120(3):489-96. doi:10.1542/peds.2007-0252
  5. Mijovic H, Sadarangani M. To LP or not to LP? Identifying the Etiology of Pediatric Meningitis. The Pediatric Infectious Disease Journal. 2019;38(6S):S39-42. doi:10.1097/INF.0000000000002313
  6. McGill F, Griffiths MJ, Solomon T. Viral meningitis: current issues in diagnosis and treatment. Current opinion in infectious diseases. 2017;30(2):248-56. doi:10.1097/QCO.0000000000000355
  7. Rudolph H, Schroten H, Tenenbaum T. Enterovirus infections of the central nervous system in children: an update. The Pediatric Infectious Disease Journal. 2016;35(5):567-9. doi:10.1097/INF.0000000000001090
  8. Kohil A, Jemmieh S, Smatti MK, Yassine HM. Viral meningitis: an overview. Archives of virology. 2021;166(1):335-45. doi:10.1007/s00705-020-04891-1
  9. Abdelrahim NA, Mohammed N, Evander M, Ahlm C, Fadl-Elmula IM. Viral meningitis in Sudanese children: Differentiation, etiology and review of literature. Medicine. 2022;101(46):1-10. doi:10.1097/MD.0000000000031588
  10. Pons-Salort M, Parker EP, Grassly NC. The epidemiology of non-polio enteroviruses: recent advances and outstanding questions. Current opinion in infectious diseases. 2015;28(5):479. doi:10.1097/QCO.0000000000000187
  11. Masri A, Dwaikat A, Haroun N, Haikal L, Kharabsheh M, Daher A, et al. Aseptic meningitis and its viral etiologies, clinical characteristics and management practices in children: a retrospective hospital-based study from Jordan. Cureus. 2022;14(4):1-7. doi:10.7759/cureus.24383
  12. Logan SA, MacMahon E. Viral meningitis. Bmj. 2008;336(7634):36-40. doi:10.1136/bmj.39409.673657.AE
  13. Pires FR, Franco AC, Gilio AE, Troster EJ. Comparison of enterovirus detection in cerebrospinal fluid with Bacterial Meningitis Score in children. Einstein (Sao Paulo). 2017;15(2):167-72. doi:10.1590/S1679-45082017AO3880
  14. Jordan KS, Freer S, House DT, Hallman MG. Viral meningitis: a pediatric case study. Advanced emergency nursing journal. 2020;42(4):254-61. doi:10.1097/TME.0000000000000318
  15. WHO and Ministry of Health Conduct Joint Investigation and develop response plan for meningitis outbreak in Halabjah and sulaymaniyah. World Health Organization; [cited 2024 Feb 13]. Available from: https://www.emro.who.int/iraq/news/who-and-ministry-of-health-conduct-joint-investigation-and-response-plan-for-meningitis-outbreak-in-halabjah-and-sulaymaniyah.html
  16. Caballero PJ, Escudero FM, Carretero SM, Pérez AV. Descriptive analysis of viral meningitis in a general hospital: differences in the characteristics between children and adults. Neurología (English Edition). 2011;26(8):468-73. doi:10.1016/j.nrl.2010.12.010
  17. Ai J, Xie Z, Liu G, Chen Z, Yang Y, Li Y, et al. Etiology and prognosis of acute viral encephalitis and meningitis in Chinese children: a multicentre prospective study. BMC infectious diseases. 2017;17(1):1-7. doi:10.1186/s12879-017-2572-9
  18. Wieczorek M, Figas A, Krzysztoszek A. Enteroviruses associated with aseptic meningitis in Poland, 2011–2014. Polish journal of microbiology. 2016;65(2):231-5. doi:N/A
  19. Rudolph H, Prieto Dernbach R, Walka M, Rey-Hinterkopf P, Melichar V, Muschiol E, et al. Comparison of clinical and laboratory characteristics during two major paediatric meningitis outbreaks of echovirus 30 and other non-polio enteroviruses in Germany in 2008 and 2013. European Journal of Clinical Microbiology & Infectious Diseases. 2017;36(1):1651-60. doi:10.1007/s10096-017-2979-7
  20. Pinheiro I, Dejager L, Libert C. X‐chromosome‐located microRNAs in immunity: might they explain male/female differences? The X chromosome‐genomic context may affect X‐located miRNAs and downstream signaling, thereby contributing to the enhanced immune response of females. Bioessays. 2011;33(11):791-802. doi:10.1002/bies.201100047
  21. Peer V, Schwartz N, Green MS. Consistent, excess viral meningitis incidence rates in young males: a multi-country, multi-year, meta-analysis of national data. The importance of sex as a biological variable. EClinicalMedicine. 2019;15:62-71. doi:10.1016/j.eclinm.2019.08.006
  22. Rice P. Viral meningitis and encephalitis. Medicine. 2017;45(11):664-9. doi:10.1016/j.mpmed.2017.08.009
  23. Itani T, Chalapa V, Semenov A, Sergeev A. Laboratory diagnosis of nonpolio enteroviruses: A review of the current literature. Biosafety and Health. 2023 Apr 1;5(2):112-9. doi:10.1161/01.CIR.101.3.231
  24. Geteneh A, Kassa T, Alemu D, Kiros M, Andualem H, Tenna A, et al. Viral etiologies of meningitis in patients with presumed pyogenic meningitis at university hospitals in Ethiopia. Infection and Drug Resistance. 2021:1083-8. doi:N/A
  25. Shahan B, Choi EY, Nieves G. Cerebrospinal fluid analysis. American Family Physician. 2021;103(7):422-8. doi:N/A
  26. Shukla B, Aguilera EA, Salazar L, Wootton SH, Kaewpoowat Q, Hasbun R. Aseptic meningitis in adults and children: Diagnostic and management challenges. Journal of clinical virology. 2017;94(1):110-4. doi:10.1016/j.jcv.2017.07.016
  27. Jaijakul S, Salazar L, Wootton SH, Aguilera E, Hasbun R. The clinical significance of neutrophilic pleocytosis in cerebrospinal fluid in patients with viral central nervous system infections. International Journal of Infectious Diseases. 2017;59(1):77-81. doi:10.1016/j.ijid.2017.04.010
  28. Bolojan BM, Cambrea SC. Enterovirus Meningitis in Children from Constanta. ARS Medica Tomitana. 2017;23(4):212-6. doi:10.1515/arsm-2017-0039

Send mail to Author


Send Cancel
Themes by Openjournaltheme.com