{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T08:37:12Z","timestamp":1790930232478,"version":"4.1.0"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T00:00:00Z","timestamp":1707696000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001713","name":"European and Developing Countries Clinical Trials Partnership","doi-asserted-by":"publisher","award":["EDCTP Reg\/Grant RIA2016E-1609"],"award-info":[{"award-number":["EDCTP Reg\/Grant RIA2016E-1609"]}],"id":[{"id":"10.13039\/501100001713","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001713","name":"European and Developing Countries Clinical Trials Partnership","doi-asserted-by":"publisher","award":["EDCTP Reg\/Grant RIA2016E-1609"],"award-info":[{"award-number":["EDCTP Reg\/Grant RIA2016E-1609"]}],"id":[{"id":"10.13039\/501100001713","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Viral encephalitis is a rare, yet severe neurological disorder. It poses a significant public health threat due to its high morbidity and mortality. Despite the disproportionate burden of the disease in impoverished African countries, the true extent of the problem remains elusive due to the scarcity of accurate diagnostic methods. The absence of timely and effective diagnostic tools, particularly Real-time Polymerase Chain Reaction, has led to misguided treatment, and an underestimation of the disease burden in Ghana. We conducted a prospective cross-sectional study to determine the viral aetiologies of encephalitis among patients presenting to a major referral hospital in Ghana from May 2019 and August 2022. The study aimed at providing a comprehensive information on the clinical epidemiology, and outcomes of viral encephalitis in Ghana. Clinical samples were collected from patients presenting with signs and symptoms of encephalitis and tested for viral agents using real-time polymerase chain reaction. We assessed the clinical epidemiology, risk factors and outcome of individuals using descriptive and logistic regression analysis. Seventy-seven (77) patients were enrolled unto the study. The participants frequently presented with fever (85.7%), seizures (80.5%), lethargy (64.9%) and headache (50.6%). Viruses were detected in 40.3% of the study participants in either cerebrospinal fluid, rectal or oral swab samples. The most frequently detected viruses were cytomegalovirus (48.4%), enteroviruses (38.7%) and HSV (29.0%). Twenty-one (27.3%) of the patients died while on hospital admission. Gender (OR = 5.70 (1.536\u20131.172), <jats:italic>p = 0<\/jats:italic>.<jats:italic>01<\/jats:italic>), and negative polymerase chain reaction test results were identified as significant factors associated with death. Antiviral treatment increased the chance of survival of viral encephalitis patients by 21.8%. Our results validate the crucial role of molecular tools as essential for the rapid diagnosis of viral encephalitis, enabling effective treatment and improved patient outcomes. This study contributes valuable epidemiological and clinical insight into viral encephalitis in Ghana.<\/jats:p>","DOI":"10.1371\/journal.pone.0297277","type":"journal-article","created":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T18:32:32Z","timestamp":1707762752000},"page":"e0297277","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical epidemiology, determinants, and outcomes of viral encephalitis in Ghana; a cross-sectional study"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2765-6179","authenticated-orcid":true,"given":"Richmond","family":"Yeboah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richmond","family":"Gorman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry Kyeremateng","family":"Acheampong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuella","family":"Nyarko-Afriyie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherihane","family":"Aryeetey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrietta Dede","family":"Tetteh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Owusu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric Smart","family":"Yeboah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Titus","family":"Adade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Bonney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaw Ampem","family":"Amoako","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"El-Duah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwasi","family":"Obiri-Danso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Drosten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8992-0222","authenticated-orcid":true,"given":"Richard Odame","family":"Phillips","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7691-914X","authenticated-orcid":true,"given":"Augustina Angelina","family":"Sylverken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,2,12]]},"reference":[{"key":"pone.0297277.ref001","first-page":"2527","volume-title":"Encephalitis: a global problem deserving of a global approach","author":"CA Glaser","year":"2020"},{"issue":"272","key":"pone.0297277.ref002","first-page":"88","article-title":"Selected viral neuroinfections in children","volume":"46","author":"K Krawczuk","year":"2019","journal-title":"Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego"},{"issue":"1","key":"pone.0297277.ref003","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1002\/ana.25131","article-title":"Autoimmune encephalitis epidemiology and a comparison to infectious encephalitis","volume":"83","author":"D Dubey","year":"2018","journal-title":"Annals of Neurology"},{"issue":"4","key":"pone.0297277.ref004","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1111\/tmi.13539","article-title":"Encephalitis and meningitis in Western Africa: a scoping review of pathogens","volume":"26","author":"SJ Rezaei","year":"2021","journal-title":"Tropical Medicine & International Health"},{"issue":"12","key":"pone.0297277.ref005","doi-asserted-by":"crossref","first-page":"1838","DOI":"10.1086\/648419","article-title":"Committee botS, Group tI. Infectious encephalitis in France in 2007: a national prospective study","volume":"49","author":"A Mailles","year":"2009","journal-title":"Clinical Infectious Diseases"},{"issue":"1","key":"pone.0297277.ref006","doi-asserted-by":"crossref","first-page":"90","DOI":"10.3201\/eid2601.191085","article-title":"Tick-borne encephalitis virus, United Kingdom","volume":"26","author":"M Holding","year":"2020","journal-title":"Emerging Infectious Diseases"},{"issue":"10","key":"pone.0297277.ref007","doi-asserted-by":"crossref","first-page":"1964","DOI":"10.3201\/eid2310.161986","article-title":"Diagnosis of fatal human case of St. Louis encephalitis virus infection by metagenomic sequencing, California, 2016","volume":"23","author":"CY Chiu","year":"2017","journal-title":"Emerging infectious diseases"},{"issue":"1","key":"pone.0297277.ref008","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41598-019-38975-z","article-title":"Viral metagenomics revealed novel betatorquevirus species in pediatric inpatients with encephalitis\/meningoencephalitis from Ghana","volume":"9","author":"D Eibach","year":"2019","journal-title":"Scientific reports"},{"issue":"1","key":"pone.0297277.ref009","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13256-021-03164-y","article-title":"Rabies is still a fatal but neglected disease: a case report","volume":"15","author":"Y Amoako","year":"2021","journal-title":"Journal of Medical Case Reports"},{"issue":"1","key":"pone.0297277.ref010","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12985-022-01854-7","article-title":"Genetic characterization of varicella-zoster and HIV-1 viruses from the cerebrospinal fluid of a co-infected encephalitic patient, Ghana","volume":"19","author":"P El-Duah","year":"2022","journal-title":"Virology journal"},{"issue":"1","key":"pone.0297277.ref011","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/S1386-6532(02)00022-7","article-title":"Development and clinical application of a fully controlled quantitative PCR assay for cell-free cytomegalovirus in human plasma","volume":"26","author":"W Preiser","year":"2003","journal-title":"J Clin Virol"},{"issue":"24","key":"pone.0297277.ref012","doi-asserted-by":"crossref","first-page":"13315","DOI":"10.1128\/JVI.01167-07","article-title":"Type I interferon production during herpes simplex virus infection is controlled by cell-type-specific viral recognition through Toll-like receptor 9, the mitochondrial antiviral signaling protein pathway, and novel recognition systems","volume":"81","author":"SB Rasmussen","year":"2007","journal-title":"J Virol"},{"issue":"1","key":"pone.0297277.ref013","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.jcv.2007.11.016","article-title":"Rapid routine detection of enterovirus RNA in cerebrospinal fluid by a one-step real-time RT-PCR assay","volume":"42","author":"U Dierssen","year":"2008","journal-title":"J Clin Virol"},{"issue":"1","key":"pone.0297277.ref014","doi-asserted-by":"crossref","first-page":"e0005258","DOI":"10.1371\/journal.pntd.0005258","article-title":"A Pan-Lyssavirus Taqman Real-Time RT-PCR Assay for the Detection of Highly Variable Rabies virus and Other Lyssaviruses","volume":"11","author":"A Wadhwa","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"key":"pone.0297277.ref015","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.jviromet.2016.12.019","article-title":"Development and validation of sensitive real-time RT-PCR assay for broad detection of rabies virus","volume":"243","author":"M Faye","year":"2017","journal-title":"Journal of virological methods"},{"key":"pone.0297277.ref016","doi-asserted-by":"crossref","first-page":"bcr2016214555","DOI":"10.1136\/bcr-2016-214555","article-title":"Detection of varicella-zoster virus DNA during medullary and brainstem relapses in multiple sclerosis","volume":"2016","author":"O Torkildsen","year":"2016","journal-title":"BMJ Case Rep"},{"issue":"8","key":"pone.0297277.ref017","doi-asserted-by":"crossref","first-page":"4588","DOI":"10.1128\/JVI.02932-14","article-title":"A novel rhabdovirus isolated from the straw-colored fruit bat Eidolon helvum, with signs of antibodies in swine and humans","volume":"89","author":"T Binger","year":"2015","journal-title":"J Virol"},{"issue":"20","key":"pone.0297277.ref018","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.1001\/jama.2013.281053","article-title":"World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects","volume":"310","author":"JAMA","year":"2013","journal-title":"JAMA"},{"issue":"5","key":"pone.0297277.ref019","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1111\/j.1468-1331.2005.01126.x","article-title":"Viral encephalitis: a review of diagnostic methods and guidelines for management","volume":"12","author":"I Steiner","year":"2005","journal-title":"European journal of Neurology"},{"issue":"5","key":"pone.0297277.ref020","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11910-016-0650-9","article-title":"The clinical approach to encephalitis","volume":"16","author":"AL Piquet","year":"2016","journal-title":"Current neurology and neuroscience reports"},{"issue":"10","key":"pone.0297277.ref021","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1097\/INF.0000000000002709","article-title":"Acute childhood viral encephalitis in southern Brazil","volume":"39","author":"DA do Valle","year":"2020","journal-title":"The Pediatric Infectious Disease Journal"},{"issue":"1","key":"pone.0297277.ref022","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1136\/archdischild-2015-308468","article-title":"Encephalitis in Australian children: contemporary trends in hospitalisation","volume":"101","author":"PN Britton","year":"2016","journal-title":"Archives of disease in childhood"},{"issue":"6","key":"pone.0297277.ref023","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.ejpn.2007.12.009","article-title":"Childhood encephalitis in Sweden: etiology, clinical presentation and outcome","volume":"12","author":"\u00c5 Fowler","year":"2008","journal-title":"European Journal of Paediatric Neurology"},{"issue":"2","key":"pone.0297277.ref024","doi-asserted-by":"crossref","first-page":"234","DOI":"10.3201\/eid0902.020218","article-title":"Viral encephalitis in England, 1989\u20131998: what did we miss?","volume":"9","author":"KL Davison","year":"2003","journal-title":"Emerging infectious diseases"},{"issue":"3","key":"pone.0297277.ref025","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.it.2013.10.006","article-title":"SeXX matters in immunity","volume":"35","author":"J Markle","year":"2014","journal-title":"Trends in immunology"},{"issue":"9","key":"pone.0297277.ref026","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1212\/WNL.0b013e3182a2cc6d","article-title":"Predictors of outcome in acute encephalitis","volume":"81","author":"KT Thakur","year":"2013","journal-title":"Neurology"},{"issue":"4","key":"pone.0297277.ref027","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1212\/WNL.0000000000001190","article-title":"The spectrum of acute encephalitis: causes, management, and predictors of outcome","volume":"84","author":"TD Singh","year":"2015","journal-title":"Neurology"},{"issue":"5","key":"pone.0297277.ref028","doi-asserted-by":"crossref","first-page":"871","DOI":"10.3390\/v14050871","article-title":"Surveillance of Viral Encephalitis in the Context of COVID-19: A One-Year Observational Study among Hospitalized Patients in Dakar, Senegal","volume":"14","author":"J Kahwagi","year":"2022","journal-title":"Viruses"},{"issue":"3","key":"pone.0297277.ref029","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1038\/nrmicro1794","article-title":"Chromatin control of herpes simplex virus lytic and latent infection","volume":"6","author":"DM Knipe","year":"2008","journal-title":"Nature reviews Microbiology"},{"issue":"12","key":"pone.0297277.ref030","doi-asserted-by":"crossref","first-page":"2172","DOI":"10.1002\/jmv.22169","article-title":"Molecular detection of viral causes of encephalitis and meningitis in New York State","volume":"83","author":"M Dupuis","year":"2011","journal-title":"Journal of medical virology"},{"issue":"1","key":"pone.0297277.ref031","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.jns.2011.01.012","article-title":"Review of the etiologies of viral meningitis and encephalitis in a dengue endemic region","volume":"303","author":"CN Soares","year":"2011","journal-title":"Journal of the Neurological Sciences"},{"issue":"Suppl 1","key":"pone.0297277.ref032","first-page":"12","article-title":"Viral encephalitis: a practical review on diagnostic approach and treatment.","volume":"96","author":"Sato DK Costa BKd","year":"2020","journal-title":"Jornal de Pediatria"},{"issue":"1","key":"pone.0297277.ref033","first-page":"145","article-title":"Encephalitis in US children","volume":"32","author":"K Messacar","year":"2018","journal-title":"Infectious Disease Clinics"},{"issue":"2","key":"pone.0297277.ref034","doi-asserted-by":"crossref","first-page":"e00105","DOI":"10.1128\/CMR.00105-19","article-title":"Immunomodulatory Strategies in Herpes Simplex Virus Encephalitis","volume":"33","author":"J Piret","year":"2020","journal-title":"Clin Microbiol Rev"},{"issue":"2","key":"pone.0297277.ref035","doi-asserted-by":"crossref","first-page":"155","DOI":"10.7861\/clinmedicine.18-2-155","article-title":"Acute encephalitis\u2013diagnosis and management","volume":"18","author":"M Ellul","year":"2018","journal-title":"Clinical Medicine"},{"issue":"924","key":"pone.0297277.ref036","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1136\/pmj.78.924.575","article-title":"Diagnosis and treatment of viral encephalitis.","volume":"78","author":"A Chaudhuri","year":"2002","journal-title":"Postgrad Med J"},{"issue":"1","key":"pone.0297277.ref037","doi-asserted-by":"crossref","first-page":"e29652","DOI":"10.1371\/journal.pone.0029652","article-title":"Antiviral therapy and outcomes of patients with pneumonia caused by influenza A pandemic (H1N1) virus","volume":"7","author":"SG Yang","year":"2012","journal-title":"PLoS One"},{"key":"pone.0297277.ref038","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1086\/589747","article-title":"The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America","author":"AR Tunkel","year":"2008","journal-title":"Clinical infectious diseases"},{"issue":"3","key":"pone.0297277.ref039","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1097\/QCO.0000000000000554","article-title":"Herpes simplex virus encephalitis update.","volume":"32","author":"JP Stahl","year":"2019","journal-title":"Curr Opin Infect Dis"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0297277","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T18:32:58Z","timestamp":1707762778000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0297277"}},"subtitle":[],"editor":[{"given":"Surangi","family":"Jayakody","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,2,12]]},"references-count":39,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0297277","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,12]]}}}