The emergence of arboviruses changes the profile of viral meningitis in Salvador, Bahia: A case series

Abstract

Background: Recently, different arboviruses became endemic in Brazil mostlycausing acute febrile illnesses, however, neurological manifestations have alsobeen reported. This study aimed to investigate which viruses were involved inthe meningitis etiology and the contribution of the circulating arboviruses inSalvador, Bahia, Brazil.Methods: From June 2014 to February 2016, 170 patients with suspected viralmeningitis were identified in Couto Maia Hospital, Salvador-BA, Brazil. TheirCSF samples were investigated for possible viral etiology by reversetranscription-PCR (RT-PCR) for different arboviruses: DENV, ZIKV and CHIKV;and for the EV; and by PCR for the HHV1-5 complex (HSV1-2, VZV, EBV andCMV). Also, ELISA was carried out in a subgroup of remaining samples fordetection of DENV IgM and NS1 antigen, CHIKV IgM and ZIKV IgM.Results: Thirty-seven patients were PCR or ELISA positive for at least one of thestudied viruses (overall positivity 21.8%). EV was the agent most frequentlydetected (10 cases; 27.0%), along with all four DENV serotypes (10 cases;27.0%); followed by CHIKV (6 cases; 16.2%), ZIKV (6 cases; 16.2%), and Varicellazoster virus (VZV) (1 case; 2.7%). Four cases (10.8%) presented viral co-infectiondetected: DENV1 + CHIKV, DENV1 + EV, DENV4 + ZIKV, and CHIKV + ZIKV.Arboviruses (DENV, CHIKV and ZIKV) accounted for the great majority of cases(26 cases; 70.3%) of all single and co-infections: DENV has been the mostfrequently detected arbovirus (13 cases; 35.1%). Among non-arboviralmeningitis,the most common etiology was the EV (11 cases; 29.7%).Conclusions: Arboviruses accounted for the majority of identified virusesamong patients with suspected viral meningitis. In areas where they areendemic it is crucial to increase viral surveillance and consider them in thedifferential diagnosis of meningitis.