Etiology of acute meningitis and encephalitis from hospital-based surveillance in South Kazakhstan oblast, February 2017—January 2018
Bumburidi Y. Utepbergenova G. Yerezhepov B. Berdiyarova N. Kulzhanova K. Head J. Moffett D. Singer D. Angra P. Whistler T. Sejvar J.
May 2021Public Library of Science
PLoS ONE
2021#16Issue 5 May
Encephalitis and meningitis (EM) are severe infections of the central nervous system associated with high morbidity and mortality. The etiology of EM in Kazakhstan is not clearly defined, so from February 1, 2017 to January 31, 2018 we conducted hospital-based syndromic surveillance for EM at the Shymkent City Hospital, in the South Kazakhstan region. All consenting inpatients meeting a standard case definition were enrolled. Blood and cerebrospinal fluid (CSF) samples were collected for bacterial culture, and CSF samples were additionally tested by PCR for four bacterial species and three viruses using a cascading algorithm. We enrolled 556 patients. Of these, 494 were of viral etiology (including 4 probable rabies cases), 37 were of bacterial etiology, 19 were of unknown etiology and 6 were not tested. The most commonly identified pathogens included enterovirus (73%, n = 406 cases), herpes simplex virus (12.8%, n = 71), and Neisseria meningitidis (3.8%, n = 21). The incidence rates (IRs) for enteroviral and meningococcal EM were found to be 14.5 and 0.7 per 100,000 persons, respectively. The IR for bacterial EM using both PCR and culture results was 3–5 times higher compared to culture-only results. Antibacterial medicines were used to treat 97.2% (480/494) of virus-associated EM. Incorporation of PCR into routine laboratory diagnostics of EM improves diagnosis, pathogen identification, ensures IRs are not underestimated, and can help avoid unnecessary antibacterial treatment.
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Central Asian Regional Office, Centers for Disease Control and Prevention, Almaty, Kazakhstan
Shymkent City Infectious Disease Hospital–Regional Department of Health Care, Southern Kazakhstan Region, Shymkent, Kazakhstan
Department of Infectious Diseases and Phthisiatry, Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkestan, Kazakhstan
Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, United States
Public Health Institute, Oakland, CA, United States
Association of Schools and Programs of Public Health, Washington, DC, United States
Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, United States
Central Asian Regional Office
Shymkent City Infectious Disease Hospital–Regional Department of Health Care
Department of Infectious Diseases and Phthisiatry
Division of Global Health Protection
Public Health Institute
Association of Schools and Programs of Public Health
Division of High-Consequence Pathogens and Pathology
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