{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T07:51:59Z","timestamp":1783151519616,"version":"3.54.6"},"reference-count":38,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7,3]]},"abstract":"<jats:p>The etiology of infections of the central nervous system (CNS) in Nepal often remains unrecognized because of underdeveloped laboratory facilities. The aim of this study was to investigate the etiology of CNS infections in a rural area of Nepal using molecular methods. From November 2014 to February 2016, cerebrospinal fluid (CSF) was collected from 176 consecutive patients presenting at United Mission Hospital in Tansen, Nepal, with symptoms of possible CNS infection. After the CSF samples were stored and transported frozen, polymerase chain reaction (PCR) was performed in Sweden, targeting a total of 26 pathogens using the FilmArray<jats:sup>\u00ae<\/jats:sup> ME panel (BioFire, bioMerieux, Salt Lake City, UT), the MeningoFinder<jats:sup>\u00ae<\/jats:sup> 2SMART (PathoFinder, Maastricht, The Netherlands), and an in-house PCR test for dengue virus (DENV), Japanese encephalitis virus (JEV), and Nipah virus (NiV). The etiology could be determined in 23%. The bacteria detected were <jats:italic>Haemophilus influenzae<\/jats:italic> (<jats:italic>n<\/jats:italic> = 5), <jats:italic>Streptococcus pneumoniae<\/jats:italic> (<jats:italic>n<\/jats:italic> = 4), and <jats:italic>Neisseria meningitidis<\/jats:italic> (<jats:italic>n<\/jats:italic> = 1). The most common virus was enterovirus detected in eight samples, all during the monsoon season. Other viruses detected were cytomegalovirus (<jats:italic>n<\/jats:italic> = 6), varicella zoster virus (<jats:italic>n<\/jats:italic> = 5), Epstein\u2013Barr virus (<jats:italic>n<\/jats:italic> = 3), herpes simplex virus (HSV) type 1 (HSV-1) (<jats:italic>n<\/jats:italic> = 3), HSV-2 (<jats:italic>n<\/jats:italic> = 3), human herpes virus (HHV) type 6 (HHV-6) (<jats:italic>n<\/jats:italic> = 3), and HHV-7 (<jats:italic>n<\/jats:italic> = 2). <jats:italic>Cryptococcus neoformans<\/jats:italic>\/<jats:italic>gatti<\/jats:italic> was found in four samples. None of the samples were positive for DENV, JEV, or NiV. Of the patients, 67% had been exposed to antibiotics before lumbar puncture. In conclusion, the etiology could not be found in 77% of the samples, indicating that the commercial PCR panels used are not suitable in this setting. Future studies on the etiology of CNS infections in Nepal could include metagenomic techniques.<\/jats:p>","DOI":"10.4269\/ajtmh.18-0434","type":"journal-article","created":{"date-parts":[[2019,6,4]],"date-time":"2019-06-04T07:59:31Z","timestamp":1559635171000},"page":"253-259","source":"Crossref","is-referenced-by-count":18,"title":["Etiology of Central Nervous System Infections in a Rural Area of Nepal Using Molecular Approaches"],"prefix":"10.4269","volume":"101","author":[{"given":"Olof","family":"S\u00e4ll","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Faculty of Medicine and Health, \u00d6rebro University, \u00d6rebro, Sweden;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Thulin Hedberg","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, \u00d6rebro University, \u00d6rebro, Sweden;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marita","family":"Neander","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, \u00d6rebro University, \u00d6rebro, Sweden;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabina","family":"Tiwari","sequence":"additional","affiliation":[{"name":"United Mission Hospital Tansen, Tansen, Nepal;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lester","family":"Dornon","sequence":"additional","affiliation":[{"name":"United Mission Hospital Tansen, Tansen, Nepal;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabin","family":"Bom","sequence":"additional","affiliation":[{"name":"United Mission Hospital Tansen, Tansen, Nepal;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Lagerqvist","sequence":"additional","affiliation":[{"name":"Public Health Agency of Sweden, Solna, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Sundqvist","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, \u00d6rebro University, \u00d6rebro, Sweden;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"M\u00f6lling","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, \u00d6rebro University, \u00d6rebro, Sweden;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"J Cent Nerv Syst Dis","first-page":"1179573517703342","article-title":"Management of viral central nervous system infections: a primer for clinicians","volume":"9","author":"Bookstaver","year":"2017"},{"key":"b2","series-title":"Curr Opin Infect Dis","first-page":"135","article-title":"Community-acquired bacterial meningitis","volume":"30","author":"Costerus","year":"2017"},{"key":"b3","series-title":"Neurology","first-page":"75","article-title":"Etiology of aseptic meningitis and encephalitis in an adult population","volume":"66","author":"Kupila","year":"2006"},{"key":"b4","series-title":"J Clin Microbiol","first-page":"1197","article-title":"State-of-the-art microbiologic testing for community-acquired meningitis and encephalitis","volume":"54","author":"Polage","year":"2016"},{"key":"b5","series-title":"Clin Microbiol Infect","first-page":"601","article-title":"Update on community-acquired bacterial meningitis: guidance and challenges","volume":"23","author":"van Ettekoven","year":"2017"},{"key":"b6","series-title":"BMC Pediatr","first-page":"94","article-title":"Bacterial meningitis in children under 15 years of age in Nepal","volume":"15","author":"Shrestha","year":"2015"},{"key":"b7","series-title":"Indian J Pediatr","first-page":"1109","article-title":"Clinical and etiological profile of acute febrile encephalopathy in eastern Nepal","volume":"76","author":"Singh","year":"2009"},{"key":"b8","series-title":"Sci Rep","first-page":"2382","article-title":"Aetiologies of central nervous system infections in adults in Kathmandu, Nepal: a prospective hospital-based study","volume":"3","author":"Giri","year":"2013"},{"key":"b9","series-title":"Int J Infect Dis","first-page":"e17","article-title":"The burden of vaccine-preventable invasive bacterial infections and pneumonia in children admitted to hospital in urban Nepal","volume":"15","author":"Kelly","year":"2011"},{"key":"b10","series-title":"Clin Microbiol Infect","first-page":"137","article-title":"Dynamics of PCR-based diagnosis in patients with invasive meningococcal disease","volume":"12","author":"Bronska","year":"2006"},{"key":"b11","series-title":"Arch Pathol Lab Med","first-page":"636","article-title":"Impact of a rapid respiratory panel test on patient outcomes","volume":"139","author":"Rogers","year":"2015"},{"key":"b12","series-title":"Lancet Neurol","first-page":"637","article-title":"The diagnosis and management of acute bacterial meningitis in resource-poor settings","volume":"7","author":"Scarborough","year":"2008"},{"key":"b13","series-title":"Diagn Microbiol Infect Dis","first-page":"268","article-title":"Diagnostic performance of a multiplex PCR assay for meningitis in an HIV-infected population in Uganda","volume":"84","author":"Rhein","year":"2016"},{"key":"b14","series-title":"BMC Infect Dis","first-page":"684","article-title":"New molecular tools for meningitis diagnostics in Ethiopia\u2013a necessary step towards improving antimicrobial prescription","volume":"18","author":"B\u00e5rnes","year":"2108"},{"key":"b15","series-title":"Neurol Sci","first-page":"81","article-title":"FilmArray\u00ae meningitis\/encephalitis (ME) panel, a rapid molecular platform for diagnosis of CNS infections in a tertiary care hospital in North India: one-and-half-year review","volume":"40","author":"Tarai","year":"2019"},{"key":"b16","series-title":"Annual Report 2071\/72 (2014\/2015)","author":"Services DoH","year":"2016"},{"key":"b17","series-title":"PLoS One","first-page":"e0180591","article-title":"Spatio-temporal epidemiology of Japanese encephalitis in Nepal, 2007\u20132015","volume":"12","author":"Kumar Pant","year":"2017"},{"key":"b18","series-title":"PLoS Negl Trop Dis","first-page":"e0005866","article-title":"Updated estimation of the impact of a Japanese encephalitis immunization program with live, attenuated SA 14-14-2 vaccine in Nepal","volume":"11","author":"Upreti","year":"2017"},{"key":"b19","series-title":"J Clin Microbiol","first-page":"2251","article-title":"Multicenter evaluation of BioFire FilmArray meningitis\/encephalitis panel for detection of bacteria, viruses, and yeast in cerebrospinal fluid specimens","volume":"54","author":"Leber","year":"2016"},{"key":"b20","series-title":"J Microbiol Methods","first-page":"113","article-title":"Evaluation of the FilmArray\u2122 meningitis\/encephalitis panel with focus on bacteria and Cryptococcus spp","volume":"157","author":"Nestor","year":"2019"},{"key":"b21","series-title":"Curr Issues Mol Biol","first-page":"59","article-title":"Comparing viral metagenomic extraction methods","volume":"24","author":"Klenner","year":"2017"},{"key":"b22","series-title":"PLoS Negl Trop Dis","first-page":"e3416","article-title":"Universal single-probe RT-PCR assay for diagnosis of dengue virus infections","volume":"8","author":"Alm","year":"2014"},{"key":"b23","series-title":"APMIS","first-page":"856","article-title":"Real-time PCR detection of five prevalent bacteria causing acute meningitis","volume":"117","author":"Hedberg","year":"2009"},{"key":"b24","series-title":"Clin Microbiol Rev","first-page":"467","article-title":"Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis","volume":"23","author":"Brouwer","year":"2010"},{"key":"b25","series-title":"J Clin Virol","first-page":"11","article-title":"Recommendations for enterovirus diagnostics and characterisation within and beyond Europe","volume":"101","author":"Harvala","year":"2018"},{"key":"b26","series-title":"J Med Virol","first-page":"161","article-title":"HHV-6 and seizure: a systematic review and meta-analysis","volume":"89","author":"Mohammadpour Touserkani","year":"2017"},{"key":"b27","series-title":"J Clin Microbiol","first-page":"e01875-17","article-title":"Nipah virus infection","volume":"56","author":"Ang","year":"2018"},{"key":"b28","series-title":"Natl Med J India","first-page":"212","article-title":"Changing landscape of acute encephalitis syndrome in India: a systematic review","volume":"25","author":"Joshi","year":"2012"},{"key":"b29","series-title":"J Vector Borne Dis","first-page":"311","article-title":"Aetiology of acute encephalitis syndrome in Uttar Pradesh, India from 2014 to 2016","volume":"54","author":"Jain","year":"2017"},{"key":"b30","series-title":"Am J Trop Med Hyg","first-page":"670","article-title":"The etiology of febrile illness in adults presenting to Patan hospital in Kathmandu, Nepal","volume":"70","author":"Murdoch","year":"2004"},{"key":"b31","series-title":"J Infect Dis","first-page":"S214","article-title":"High rates of enteric fever diagnosis and lower burden of culture-confirmed disease in peri-urban and rural Nepal","volume":"218","author":"Andrews","year":"2018"},{"key":"b32","series-title":"PLoS One","first-page":"e0129869","article-title":"Climate change and spatiotemporal distributions of vector-borne diseases in Nepal\u2013a systematic synthesis of literature","volume":"10","author":"Dhimal","year":"2015"},{"key":"b33","series-title":"Lancet","first-page":"1760","article-title":"Managing MDR tuberculosis in Nepal","volume":"391","author":"Cousins","year":"2018"},{"key":"b34","series-title":"Ann Clin Microbiol Antimicrob","first-page":"32","article-title":"The dengue virus in Nepal: gaps in diagnosis and surveillance","volume":"17","author":"Gupta","year":"2018"},{"key":"b35","series-title":"Comput Struct Biotechnol J","first-page":"108","article-title":"Highlighting clinical metagenomics for enhanced diagnostic decision-making: a step towards wider implementation","volume":"16","author":"Forbes","year":"2018"},{"key":"b36","series-title":"J Infect","first-page":"225","article-title":"Encephalitis diagnosis using metagenomics: application of next generation sequencing for undiagnosed cases","volume":"76","author":"Brown","year":"2018"},{"key":"b37","series-title":"Clin Microbiol Infect","first-page":"30812","article-title":"High-throughput sequencing for the aetiologic identification of viral encephalitis, meningoencephalitis, and meningitis. 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