Background: Encephalitis is a serious neurological syndrome that can be caused by various infectious agents, particularly in immunocompromised individuals. Among these agents, viruses from the Herpesviridae family play a major role, although their diagnosis is often underestimated and their involvement remains poorly understood, particularly in developing countries such as those in West Africa. Aim: This cross-sectional, descriptive, multicenter study was conducted in hospitals in two regions of C?te d’Ivoire, namely Abidjan and Bouaké, between March 2024 and April 2025 to assess the prevalence of herpesviruses. Methods: CSF samples were collected from patients aged ≥ 15 years who presented with clinical signs of encephalitis and were subjected to molecular analysis. Viral DNA extraction and PCR tests were used to detect Herpes simplex virus 1 and 2 (HSV 1/2), Varicella-Zoster virus (VZV), Epstein-Barr virus (EBV), Cytomegalovirus (CMV), and Human herpesvirus 6 (HHV6). Clinical data and molecular analysis results were recorded using Excel software, and statistical analysis was performed using RStudio 4.2.1 software. Results are presented as mean and standard deviation for quantitative variables and as percentages for qualitative variables. Results: A total of 388 patients were included in this study (222 women and 166 men; age range 15 - 79 years; mean age 45.36 ± 13.55 years), and 60 (15.46%) were positive for one or more herpesvirus. Epstein-Barr virus was most frequently detected in 33 (55.00%) of positive cases, followed by Cytomegalovirus with 20 (33.33%) and Varicella-Zoster virus and Human herpes virus 6 with respective rates of 20.00% (12) for VZV and 11.67% (07) for HHV6. A single Herpes simplex virus (1.67%) was detected. Among the patients with a positive PCR, 10 (16.67%) were co-infected with herpesviruses. All co-infected patients were HIV seropositive. The chi-square test showed a significant association between HIV infection status and the molecular detection of herpesvirus in patients with encephalitis (OR 3.9; 95% CI: [1.4 - 9.3]; P < 0.0015). Conclusion: Herpesviruses are a significant cause of encephalitis, particularly in immunocompromised and immunocompetent patients. In our study, EBV and CMV were the most common. Therefore, the rapid identification of these viruses in the CSF and the initiation of appropriate antiviral treatment are essential to reduce mortality and improve the management of
References
[1]
Jmor, F., Emsley, H.C., Fischer, M., Solomon, T. and Lewthwaite, P. (2008) The Incidence of Acute Encephalitis Syndrome in Western Industrialised and Tropical Countries. Virology Journal, 5, Article No. 134. https://doi.org/10.1186/1743-422x-5-134
[2]
Wang, H., Zhao, S., Wang, S., Zheng, Y., Wang, S., Chen, H., et al. (2022) Global Magnitude of Encephalitis Burden and Its Evolving Pattern over the Past 30 Years. Journal of Infection, 84, 777-787. https://doi.org/10.1016/j.jinf.2022.04.026
[3]
OMS Afrique (2022) Atlas des statistiques sanitaires africaines 2022. Analyse de la situation sanitaire de la Région africaine. https://iris.who.int/bitstream/handle/10665/364853/9789290313755-fre.pdf?sequence=1&isAllowed=y
[4]
Brown, J.R., Bharucha, T. and Breuer, J. (2018) Encephalitis Diagnosis Using Metagenomics: Application of Next Generation Sequencing for Undiagnosed Cases. Journal of Infection, 76, 225-240. https://doi.org/10.1016/j.jinf.2017.12.014
[5]
Rezaei, S.J. and Mateen, F.J. (2021) Encephalitis and Meningitis in Western Africa: A Scoping Review of Pathogens. Tropical Medicine & International Health, 26, 388-396. https://doi.org/10.1111/tmi.13539
[6]
Graus, F., Titulaer, M.J., Balu, R., et al. (2016) A Clinical Approach to Diagnosis of Autoimmune Encephalitis. The Lancet Neurology, 15, 391-404.
[7]
de Ory, F., Avellón, A., Echevarría, J.E., Sánchez-Seco, M.P., Trallero, G., Cabrerizo, M., et al. (2013) Viral Infections of the Central Nervous System in Spain: A Prospective Study. Journal of Medical Virology, 85, 554-562. https://doi.org/10.1002/jmv.23470
[8]
Mailles, A. and Stahl, J. (2009) Infectious Encephalitis in France in 2007: A National Prospective Study. Clinical Infectious Diseases, 49, 1838-1847. https://doi.org/10.1086/648419
[9]
DeBiasi, R.L. and Tyler, K.L. (2004) Molecular Methods for Diagnosis of Viral Encephalitis. ClinicalMicrobiologyReviews, 17, 903-925. https://doi.org/10.1128/cmr.17.4.903-925.2004
[10]
Rki (2018) Epidemiologisches Bulletin des Robert Koch-Instituts Ausgabe 48/2019.
[11]
Chiu, C.Y., Coffey, L.L., Murkey, J., Symmes, K., Sample, H.A., Wilson, M.R., et al. (2017) Diagnosis of Fatal Human Case of St. Louis Encephalitis Virus Infection by Metagenomic Sequencing, California, 2016. Emerging Infectious Diseases, 23, 1964-1968. https://doi.org/10.3201/eid2310.161986
[12]
Berrington, W.R., Jerome, K.R., Cook, L., Wald, A., Corey, L. and Casper, C. (2009) Clinical Correlates of Herpes Simplex Virus Viremia among Hospitalized Adults. Clinical Infectious Diseases, 49, 1295-1301. https://doi.org/10.1086/606053
[13]
Smith, C.A., Conroy, L.T., Pollock, M., Ruddy, J., Binning, A. and McCruden, E.A.B. (2010) Detection of Herpes Viruses in Respiratory Secretions of Patients Undergoing Artificial Ventilation. Journal of Medical Virology, 82, 1406-1409. https://doi.org/10.1002/jmv.21794
[14]
Magurano, F., Baggieri, M., Marchi, A., Bucci, P., Rezza, G. and Nicoletti, L. (2018) Mumps Clinical Diagnostic Uncertainty. European Journal of Public Health, 28, 119-123. https://doi.org/10.1093/eurpub/ckx067
[15]
Sugita, S., Shimizu, N., Watanabe, K., Ogawa, M., Maruyama, K., Usui, N., et al. (2012) Virological Analysis in Patients with Human Herpes Virus 6–Associated Ocular Inflammatory Disorders. Investigative Opthalmology & Visual Science, 53, 4692-4698. https://doi.org/10.1167/iovs.12-10095
[16]
Bienes, K.M., Mao, L., Selekon, B., Gonofio, E., Nakoune, E., Wong, G., et al. (2022) Rapid Detection of the Varicella-Zoster Virus Using a Recombinase-Aided Amplification-Lateral Flow System. Diagnostics, 12, Article 2957. https://doi.org/10.3390/diagnostics12122957
[17]
World Medical Association Declaration of Helsinki (2013) World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. American Medical Association.
[18]
Binger, T., Annan, A., Drexler, J.F., Müller, M.A., Kallies, R., Adankwah, E., et al. (2015) A Novel Rhabdovirus Isolated from the Straw-Colored Fruit Bat Eidolon Helvum, with Signs of Antibodies in Swine and Humans. JournalofVirology, 89, 4588-4597. https://doi.org/10.1128/jvi.02932-14
[19]
Li, L.-L., Xu, Y.L., Lu, X.X., et al. (2022) Isolation of a Novel Bat Rhabdovirus with Evidence of Human Exposure in China. mBio Journal, 13, e0287521.
[20]
Piquet, A.L. and Cho, T.A. (2016) The Clinical Approach to Encephalitis. CurrentNeurologyandNeuroscienceReports, 16, Article No. 45. https://doi.org/10.1007/s11910-016-0650-9
[21]
Do Valle, D.A., Santos, M.L.S.F., Giamberardino, H.I.G., Raboni, S.M. and Scola, R.H. (2020) Acute Childhood Viral Encephalitis in Southern Brazil. PediatricInfectiousDiseaseJournal, 39, 894-898. https://doi.org/10.1097/inf.0000000000002709
[22]
Britton, P.N., Khoury, L., Booy, R., Wood, N. and Jones, C.A. (2016) Encephalitis in Australian Children: Contemporary Trends in Hospitalisation. Archives of Disease in Childhood, 101, 51-56.
[23]
Fowler, Å., Stödberg, T., Eriksson, M. and Wickström, R. (2008) Childhood Encephalitis in Sweden: Etiology, Clinical Presentation and Outcome. European Journal of Paediatric Neurology, 12, 484-490. https://doi.org/10.1016/j.ejpn.2007.12.009
[24]
Lindegger, D.J., Rossi, D.C. and Guex-Crosier, Y. (2020) Concurrent Varicella and Herpes Simplex Virus Reactivation in the Same Trigeminal Dermatome in a Person Living with HIV. International Journal of STD & AIDS, 31, 1145-1148. https://doi.org/10.1177/0956462419899003
[25]
Velagapudi, M., Onaiwu, C. and Gupta, V. (2016) Cytomegalovirus (CMV) Encephalitis in HIV Patients. Journal of Neurological Disorders, 4, No. 8. https://doi.org/10.4172/2329-6895.1000314
[26]
Mascitti, H. (2020) Infections du système nerveux Infections of the nervous system.
[27]
Li, S., Nguyen, I.P. and Urbanczyk, K. (2020) Common Infectious Diseases of the Central Nervous System—Clinical Features and Imaging Characteristics. Quantitative Imaging in Medicine and Surgery, 10, 2227-2259. https://doi.org/10.21037/qims-20-886
[28]
Sili, U., Kaya, A. and Mert, A. (2014) Herpes Simplex Virus Encephalitis: Clinical Manifestations, Diagnosis and Outcome in 106 Adult Patients. Journal of Clinical Virology, 60, 112-118. https://doi.org/10.1016/j.jcv.2014.03.010
[29]
Platz, I.L., Tetens, M.M., Dessau, R., Ellermann-Eriksen, S., Andersen, N.S., Jensen, V.V.S., et al. (2024) Characteristics and Long-Term Prognosis of Danish Residents with a Positive Intrathecal Antibody Index Test for Herpes Simplex Virus or Varicella-Zoster Virus Compared with Individuals with a Positive Cerebrospinal Fluid PCR: A Nationwide Cohort Study. Clinical Microbiology and Infection, 30, 240-246. https://doi.org/10.1016/j.cmi.2023.11.004
[30]
Mohamed, W.S., Aldabbagh, H.A., Aldughmani, H.A., et al. (2022) Prevalence of Human Herpesviruses (HHV1-7), and Its Clinical Significance in Middle Eastern Pediatric Leukemia Patients Using 2 Independent PCR Assays. Journal of Applied Microbiological Research, 5, 1-9.
[31]
Marjani, A., Hesamizadeh, K., Bokharaei-Salim, F., Khanaliha, K., Karbalaie Niya, M.H., Habib, Z., et al. (2022) Distribution of Epstein-Barr Virus and Human Herpesvirus 8 Co-Infections among Human Immunodeficiency Virus-1 Positive Patients. International Journal of Medical Laboratory, 9, 187-197. https://doi.org/10.18502/ijml.v9i3.10904
[32]
Whitley, R.J. and Kimberlin, D.W. (2005) Herpes Simplex: Encephalitis Children and Adolescents. Seminars in Pediatric Infectious Diseases, 16, 17-23. https://doi.org/10.1053/j.spid.2004.09.007
[33]
Peuchmaur, M., Voisin, J., Vaillant, M., Truffot, A., Lupo, J., Morand, P., et al. (2023) Epstein-Barr Virus Encephalitis: A Review of Case Reports from the Last 25 Years. Microorganisms, 11, Article 2825. https://doi.org/10.3390/microorganisms11122825
[34]
Campbell, J.L., Fay, M.P., Lanning, L.L. and Hewitt, J.A. (2020) Effect of Delaying Treatment on Efficacy of Ciprofloxacin and Levofloxacin in the African Green Monkey Model of Pneumonic Plague. Clinical Infectious Diseases, 70, S60-S65. https://doi.org/10.1093/cid/ciz1234
[35]
Simmons, A. (2002) Clinical Manifestations and Treatment Considerations of Herpes Simplex Virus Infection. The Journal of Infectious Diseases, 186, S71-S77. https://doi.org/10.1086/342967
[36]
Whitley, R.J. and Roizman, B. (2001) Herpes Simplex Virus Infections. The Lancet, 357, 1513-1518. https://doi.org/10.1016/s0140-6736(00)04638-9
[37]
OMS (2021) Neurological Disorders: Public Health Challenges. World Health Organization.
[38]
Granerod, J., Ambrose, H.E., Davies, N.W., Clewley, J.P., Walsh, A.L., Morgan, D., et al. (2010) Causes of Encephalitis and Differences in Their Clinical Presentations in England: A Multicentre, Population-Based Prospective Study. The Lancet Infectious Diseases, 10, 835-844. https://doi.org/10.1016/s1473-3099(10)70222-x
[39]
Ondo, W.G. (2020) Current and Emerging Treatments of Essential Tremor. Neurologic Clinics, 38, 309-323. https://doi.org/10.1016/j.ncl.2020.01.002
[40]
Perez, S., Johnson, A., Xiang, S., Li, J., Foley, B.T., Doyle-Meyers, L., et al. (2017) Persistence of SIV in the Brain of Siv-Infected Chinese Rhesus Macaques with or without Antiretroviral Therapy. Journal of NeuroVirology, 24, 62-74. https://doi.org/10.1007/s13365-017-0594-0
[41]
Petit-Pedrol, M., Armangue, T., Peng, X., Bataller, L., Cellucci, T., Davis, R., et al. (2014) Encephalitis with Refractory Seizures, Status Epilepticus, and Antibodies to the GABAA Receptor: A Case Series, Characterisation of the Antigen, and Analysis of the Effects of Antibodies. The Lancet Neurology, 13, 276-286. https://doi.org/10.1016/s1474-4422(13)70299-0
[42]
Echt, D.S., Liebson, P.R., Brent Mitchell, L., et al. (1991) Mortality and Morbidity in Patients Receiving Encainide, Flecainide, or Placebo—The Cardiac Arrtytmia Suppression Trial. The New Journal of Medicine, 324, 781-788.