G79(P) Cytomegalovirus and herpes simplex virus 1 & 2 meningitis among children with suspected meningitis at a tertiary emergency unit in Nigeria

Aim To determine the incidence of cytomegalovirus and herpes simplex virus 1 & 2 among paediatric emergencies presenting with suspected meningitis at the children’s emergency room. Methods It was a prospective cross sectional study of all consecutive paediatric emergencies over a period of three months. Patients were included in the study if they had any neurological signs such as but not limited to lethargy, coma seizures with or without fever. Clinical details were entered into a structured proforma. Cerebrospinal fluid (CSF) samples were obtained at admission and sent to the Virology Laboratory in a cold box. Deoxyribonucleic acid (DNA) extraction was done using commercially available DNA extraction kit by Jena Bioscience (Jena Germany) according to the manufacturer’s instruction. The DNA was then tested for HSV 1&2 and CMV using gene specific primers in a multiplex reaction. Positive samples were detected after agarose gel electrophoresis using a trans illuminator. Results Forty patients were recruited, 29 (72.5%) males and 11 (27.5%) females, with a mean age of 27.1±18.3 months. The most common presenting clinical features were seizures 37 (92.5%), fever 35 (87.5%), lethargy 29 (72.5%), poor feeding 23 (57.5%) and coma 11 (27.5%). Twenty (50%) the patients had CSF positive for HSV 1, 13 (32.5%) of whom were also positive for CMV and 12 (30%) for HSV 2. Eleven patients (27.5%) were positive for all three viruses. Conclusion The high incidence of viral meningitis among children with suspected meningitis is consistent with findings from high income countries. Mortality and morbidity from meningitis remain high in this setting however, viral aetiology of meningitis is rarely considered or treated. The use of antiviral agents in meningitis have been shown to reduce morbidity and mortality from viral meningitis. Antiviral agents should therefore be considered in the management of meningitis in this setting in order to improve outcomes of patients and promote judicious use of antibiotics. Further research to describe the viral aetiology of meningitis in this setting is required.