Investigations of central nervous system viral infection at UHWI, 1998-1999

Preliminary results are presented for viral infections of the CNS at UHWI between July 1998 and June 1999. A total of 168 cases were referred from the following hospitals and distributed as follows: UHWI 119 (70 percent); Bustamante Children's 31 (18 percent); Spanish Town 10 (6 percent); Kingston Public 7 (4 percent); Other 2 (1 percent). Specimens received were acute and convalescent sera, throat swabs, rectal swabs and CSF. Laboratory investigations included viral culture and serology; confirmatory methods included neutralization tests, immunofluorescence (IFA) and polymerase chain reaction (PCR). The clinical diagnoses in the 168 cases included for viral CNS investigations were submitted from only 47/168 (30 percent) of cases. Viral agents were identified in 31/47 (66 percent) of the appropriate specimens received. These viruses included enteroviruses 12/31 (38 percent), human immunodeficiency virus (HIV) 9/31 (29 percent), 3/31 (9 percent) of the HIV positive patients were also positive for toxoplasmosis), dengue 6/31 (19 percent), herpes simplex virus 1/31 (3 percent), rotavirus 1/31 (3 percent), cytomegalovirus 1/31 (3 percent) and influenza 1/31 (3 percent). Enteroviruses, HIV and dengue were the viruses most frequently associated with CNS infections among the 31 cases identified. This however is not a complete representation of CNS associated with viral agents, as appropriate specimens were received from only 30 percent of the cases. This study also demonstrated a definite need for an increased understanding of appropriate specimen collection and submission necessary for the diagnosis of viral CNS infections.(AU)