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Bir Üniversite Hastanesinde Menenjit Ön Tanılı Hastalarda HSV-1, HSV-2, VZV, EBV, CMV, HHV-6 ve HHV-7 Etkenlerinin Araştırılması

Yıl 2025, Cilt: 47 Sayı: 2, 271 - 276, 27.02.2025

Öz

Menenjit gelişmemiş ve gelişmekte olan ülkelerdeki en önemli morbidite ve mortalite nedenlerinden biridir. Menenjit etkenlerinin dağılımı yaş, mevsim, coğrafi bölge, sosyoekonomik düzey gibi birçok faktöre bağlı olarak değişmektedir. Bu çalışmanın amacı, bir üniversite hastanesindeki menenjit ön tanılı hastalarda viral menenjit etkenlerinin dağılımının araştırılmasıdır. Çalışmaya 01.04.2019-01.04.2024 tarihleri arasında çeşitli poliklinik ve servislere başvuran menenjit ön tanılı 1588 hasta dahil edildi. Hastalardan alınan beyin omurilik sıvısında (BOS), polimeraz zincir reaksiyonu (PZR) metoduyla viral etkenler araştırıldı. Çalışmamızda 17 (%1,07) hastada HHV-7, 13 (%0,81) hastada EBV, 10 hastada HHV-6 (%0,60), 8 (%0,50) hastada HSV-1, 7 (%0,44) hastada CMV, 6 (%0,37) hastada VZV, 3 (%0,18) hastada HSV-2 pozitif saptandı. Coğrafi bölgelere göre değişiklik gösteren menenjit etkenlerin sıklığını ve dağılımını bilmek uygun ampirik tedavi açısından önem arz etmektedir. Multipleks PZR metoduyla birçok patojen aynı anda araştırılarak etkenler tespit edilebilmektedir. Moleküler epidemiyolojik çalışmaların sayısı arttırılarak ülkemizdeki menenjit etkenlerinin dağılımı hakkında bilgi sahibi olabilmek oldukça önemlidir.

Etik Beyan

Etik Kurul Onayı: Çalışma Necmettin Erbakan Üniversitesi Tıbbi Cihaz ve İlaç Dışı Etik Kurulu tarafından onaylanmıştır (Karar no:2024/5154, Tarih: 06.09.2024).

Destekleyen Kurum

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Proje Numarası

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Teşekkür

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Kaynakça

  • 1. World Health Organization. Meningitis. https://www.who.int/news-room/fact-sheets/detail/meningitis Avaible : 06.01.2025
  • 2. Rorabaugh ML, Berlin LE, Heldrich F, Roberts K, Rosenberg LA, Doran T, et al. Aseptic meningitis in infants younger than 2 years of age. Acute illness and neurologic complications. Pediatrics. 1993;92:206–11.
  • 3. Tanır G. Viral Meningitis. Turkiye Klinikleri J Pediatr Sci. 2011;7(4):34-9
  • 4. Rhoades RE, Tabor-Godwin JM, Tsueng G, Feuer R. Enterovirus infections of the central nervous system. Virology. 2011;411:288–305. 10.1016/j.virol.2010.12.014.
  • 5. Tognarelli EI, Palomino TF, Corrales N, Bueno SM, Kalergis AM, González PA. Herpes simplex virus evasion of early host antiviral responses. Front Cell Infect Microb.2019;9:127.
  • 6. Davidkin I, Jokinen S, Paananen A, Leinikki P, Peltola H. Etiology of mumps-like illnesses in children and adolescents vaccinated for measles, mumps, and rubella. J Infect Dis.2005;191:719–23. 10.1086/427338.
  • 7. Jarrin I, Sellier P, Lopes A, Morgand M, Makovec T, Delcey V, et al.. Etiologies and management of aseptic meningitis in patients admitted to an internal medicine department. Medicine. 2016;95:e2372.
  • 8. De Ory F, Avellon A, Echevarria J, Sánchez-Seco M, Trallero G, Cabrerizo M, et al.. Viral infections of the central nervous system in Spain: a prospective study. J Med Virol. 2013;85:554–62.
  • 9. Calleri G, Libanore V, Corcione S, Rosa FGD, Caramello P. A retrospective study of viral central nervous system infections: Relationship amongst aetiology, clinical course and outcome. Infection. 2017;45:227–231.
  • 10. Topçu AW, Söyletir G, Doğanay M. Menenjitler: Topçu-Willke A, Söyletir G, Doğanay M (editörler), Enfeksiyon Hastalıkları ve Mikrobiyolojisi: Sistemlere Göre Enfeksiyonlar. İstanbul: Nobel Tıp Kitabevi: 2017.
  • 11. Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D, Cunningham R, Zuckerman M, Mutton KJ, Solomon T, Ward KN, Lunn MP, Irani SR, Vincent A, Brown DW, Crowcroft NS; UK Health Protection Agency (HPA) Aetiology of Encephalitis Study Group. Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis.. 2011;11(2):79.
  • 12. Petersen PT, Bodilsen J, Jepsen MPG, Larsen L, Storgaard M, Hansen BR, Helweg-Larsen J, Wiese L, Lüttichau HR, Andersen CØ, Nielsen H, Brandt CT; Danish Study Group of Infections of the Brain (DASGIB). Clinical features and prognostic factors in adults with viral meningitis. Brain. 2023;146(9):3816-3825.
  • 13. Shukla B, Aguilera EA, Salazar L, Wootton SH, Kaewpoowat Q, Hasbun R. Aseptic meningitis in adults and children: diagnostic and management challenges. J Clin Virol 2017;94:110–4.
  • 14. McGill F, Griffiths MJ, Bonnett LJ, Geretti AM, Michael BD, Beeching NJ, et al.. Incidence, aetiology, and sequelae of viral meningitis in UK adults: a multicentre prospective observational cohort study. Lancet Infect Dis. 2018;18:992–1003.
  • 15. Ben Abid F, Abukhattab M, Ghazouani H, Khalil O, Gohar A, Al Soub H, et al.. Epidemiology and clinical outcomes of viral central nervous system infections. Int J Infect Dis. 2018;73:85–90.
  • 16. Tan CS, Koralnik IJ. Progressive multifocal leukoencephalopathy and other disorders caused by JC virus: clinical features and pathogenesis. Lancet Neurol. 2010;9:425–37.
  • 17. Behzad-Behbahani A, Klapper PE, Vallely PJ, Cleator GM, Bonington A. BKV-DNA and JCV-DNA in CSF of patients with suspected meningitis or encephalitis. Infection. 2003;31:374–8.
  • 18. Bogdanovic G, Priftakis P, Hammarin A-L, Söderström M, Samuelson A, Lewensohn-Fuchs I, et al. Detection of JC virus in cerebrospinal fluid (CSF) samples from patients with progressive multifocal leukoencephalopathy but not in CSF samples from patients with herpes simplex encephalitis, enteroviral meningitis, or multiple sclerosis. J Clin Microbiol. 1998;36:1137–8.
  • 19. Akkaya O, Güvenç Hİ, Güzelant A, Kaya M, Yüksekkaya Ş, Opuş A, ark. Menenjit Etkenlerinin Real-time PZR Yöntemiyle Araştırılması. Türk Mikrobiyol Cem Derg 2017;47(3):131-37.
  • 20. Sarinoğlu RC, Sağlık İ, Mutlu D, ve ark. Beyin Omurilik Sıvısı Örneklerinden Saptanan Viral Etkenler. Türk Mikrobiyol Cem Derg. 2016; 6(4):152-158
  • 21. Soylar M, Altuğlu İ, Sertöz R, ve ark. Ege Üniversitesi Hastanesi’ne başvuran santral sinir sistemi enfeksiyonu olgularında saptanan viral etkenler. Ege Tıp Dergisi. 2014; 53(2):65-70.
  • 22. Çaycı YT, Daştan MSE, Vural DG, Bilgin K, Birinci A. Menenjit Etkenlerinin Araştırılması. J Biotechnol and Strategic Health Res. 2021;5(2):98-104.
  • 23. Aldriweesh MA, Shafaay EA, Alwatban SM, Alkethami OM, Aljuraisi FN, Bosaeed M, Alharbi NK. Viruses Causing Aseptic Meningitis: A Tertiary Medical Center Experience With a Multiplex PZR Assay. Front Neurol. 2020;11:602267.
  • 24. Roshdy WH, Kandeil A, Fahim M, Naguib NY, Mohsen G, Shawky S, Abd El-Fattah MM, Naguib A, Salamony A, Shamikh YI, Moawad M, Guindy NE, Khalifa MK, Abbas E, Galal R, Hassany M, Ibrahem M, El-Shesheny R, Asem N, Kandeel A. Epidemiological characterization of viral etiological agents of the central nervous system infections among hospitalized patients in Egypt between 2016 and 2019. Virol J. 2023 Aug 2;20(1):170
  • 25. Kupila L, Vuorinen T, Vainionpaa R, Hukkanen V, Marttila RJ, Kotilainen P. Etiology of aseptic meningitis and encephalitis in an adult population. Neurology. 2006;66:75–80.
  • 26. Mathew S, Al Khatib HA, Al Ansari K, Nader J, Nasrallah GK, Younes NN, Coyle PV, Al Thani AA, Al Maslamani MA, Yassine HM. Epidemiology Profile of Viral Meningitis Infections Among Patients in Qatar (2015-2018). Front Med (Lausanne). 2021;8:663694.
  • 27. Verstrepen WA, Kuhn S, Kockx MM, Van De Vyvere ME, Mertens AH. Rapid detection of enterovirus RNA in cerebrospinal fluid specimens with a novel single-tube real-time reverse transcription-PZR assay. J Clin Microbiol. 2001 Nov;39(11):4093-6. doi: 10.1128/JCM.39.11.4093-4096.2001. PMID: 11682535; PMCID: PMC88492.De Crom S, et al. Prospective comparison of the detection rates of human enterovirus and parechovirus RT-qPZR and viral culture in different pediatric specimens. J Clin Virol. 2013;58(2):449–454. doi: 10.1016/j.jcv.2013.07.017.
  • 28. Kupila L, Vuorinen T, Vainionpäā R, Marttila RJ, Kotilainen P. Diagnosis of enteroviral meningitis by use of polymerase chain reaction of cerebrospinal fluid, stool, and serum specimens. Clin Infect Dis. 2005 Apr 1;40(7):982-7. doi: 10.1086/428581. Epub 2005 Mar 4. PMID: 15824990.
  • 29. Kumar R. Aseptic meningitis: diagnosis and management. Indian J Pediatr. 2005;72(1):57–63. doi: 10.1007/BF02760582.
  • 30. Poplin V, Boulware DR, Bahr NC. Methods for rapid diagnosis of meningitis etiology in adults. Biomark Med. 2020;14(6):459–479.
  • 31. Aladağ Çiftdemir N, Duran R, Vatansever Özbek Ü, Hançerli Törün S, Acunaş B, Ünal Şahin N. Meningokoksemi: aynı coğrafyada farklı serotipler. Mikrobiyol Bul 2020;54(1):163-170.
  • 32. Beckham JD, Tyler KL, editors. Encephalitis. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseasea, 7th ed. 2010, 1244.

Investigation of HSV-1, HSV-2, VZV, EBV, CMV, HHV-6 and HHV-7 Agents in Patients with Pre-diagnosis of Meningitis in a University Hospital

Yıl 2025, Cilt: 47 Sayı: 2, 271 - 276, 27.02.2025

Öz

Meningitis is one of the most important causes of morbidity and mortality in underdeveloped and developing countries. The distribution of meningitis agents varies depending on many factors such as age, season, geographical region and socioeconomic level. The aim of this study was to investigate the distribution of viral meningitis agents in patients with pre-diagnosed meningitis in a university hospital. Between 01.04.2019-01.04.2024, 1588 patients with a prediagnosis of meningitis admitted to various outpatient clinics and wards were included in the study. Cerebrospinal fluid (CSF) obtained from the patients was analyzed for viral agents by polymerase chain reaction (PCR) method. In our study, 17 (1.07%) patients were positive for HHV-7, 13 (0.81%) for EBV, 10 (0.60%) for HHV-6, 8 (0.50%) for HSV-1, 7 (0.44%) for CMV, 6 (0.37%) for VZV and 3 (0.18%) for HSV-2. Knowing the frequency and distribution of meningitis agents that vary according to geographical regions is important for appropriate empirical treatment. With the multiplex PZR method, many pathogens can be investigated simultaneously and the causative agents can be identified. It is very important to have information about the distribution of meningitis agents in our country by increasing the number of molecular epidemiologic studies.

Proje Numarası

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Kaynakça

  • 1. World Health Organization. Meningitis. https://www.who.int/news-room/fact-sheets/detail/meningitis Avaible : 06.01.2025
  • 2. Rorabaugh ML, Berlin LE, Heldrich F, Roberts K, Rosenberg LA, Doran T, et al. Aseptic meningitis in infants younger than 2 years of age. Acute illness and neurologic complications. Pediatrics. 1993;92:206–11.
  • 3. Tanır G. Viral Meningitis. Turkiye Klinikleri J Pediatr Sci. 2011;7(4):34-9
  • 4. Rhoades RE, Tabor-Godwin JM, Tsueng G, Feuer R. Enterovirus infections of the central nervous system. Virology. 2011;411:288–305. 10.1016/j.virol.2010.12.014.
  • 5. Tognarelli EI, Palomino TF, Corrales N, Bueno SM, Kalergis AM, González PA. Herpes simplex virus evasion of early host antiviral responses. Front Cell Infect Microb.2019;9:127.
  • 6. Davidkin I, Jokinen S, Paananen A, Leinikki P, Peltola H. Etiology of mumps-like illnesses in children and adolescents vaccinated for measles, mumps, and rubella. J Infect Dis.2005;191:719–23. 10.1086/427338.
  • 7. Jarrin I, Sellier P, Lopes A, Morgand M, Makovec T, Delcey V, et al.. Etiologies and management of aseptic meningitis in patients admitted to an internal medicine department. Medicine. 2016;95:e2372.
  • 8. De Ory F, Avellon A, Echevarria J, Sánchez-Seco M, Trallero G, Cabrerizo M, et al.. Viral infections of the central nervous system in Spain: a prospective study. J Med Virol. 2013;85:554–62.
  • 9. Calleri G, Libanore V, Corcione S, Rosa FGD, Caramello P. A retrospective study of viral central nervous system infections: Relationship amongst aetiology, clinical course and outcome. Infection. 2017;45:227–231.
  • 10. Topçu AW, Söyletir G, Doğanay M. Menenjitler: Topçu-Willke A, Söyletir G, Doğanay M (editörler), Enfeksiyon Hastalıkları ve Mikrobiyolojisi: Sistemlere Göre Enfeksiyonlar. İstanbul: Nobel Tıp Kitabevi: 2017.
  • 11. Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D, Cunningham R, Zuckerman M, Mutton KJ, Solomon T, Ward KN, Lunn MP, Irani SR, Vincent A, Brown DW, Crowcroft NS; UK Health Protection Agency (HPA) Aetiology of Encephalitis Study Group. Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis.. 2011;11(2):79.
  • 12. Petersen PT, Bodilsen J, Jepsen MPG, Larsen L, Storgaard M, Hansen BR, Helweg-Larsen J, Wiese L, Lüttichau HR, Andersen CØ, Nielsen H, Brandt CT; Danish Study Group of Infections of the Brain (DASGIB). Clinical features and prognostic factors in adults with viral meningitis. Brain. 2023;146(9):3816-3825.
  • 13. Shukla B, Aguilera EA, Salazar L, Wootton SH, Kaewpoowat Q, Hasbun R. Aseptic meningitis in adults and children: diagnostic and management challenges. J Clin Virol 2017;94:110–4.
  • 14. McGill F, Griffiths MJ, Bonnett LJ, Geretti AM, Michael BD, Beeching NJ, et al.. Incidence, aetiology, and sequelae of viral meningitis in UK adults: a multicentre prospective observational cohort study. Lancet Infect Dis. 2018;18:992–1003.
  • 15. Ben Abid F, Abukhattab M, Ghazouani H, Khalil O, Gohar A, Al Soub H, et al.. Epidemiology and clinical outcomes of viral central nervous system infections. Int J Infect Dis. 2018;73:85–90.
  • 16. Tan CS, Koralnik IJ. Progressive multifocal leukoencephalopathy and other disorders caused by JC virus: clinical features and pathogenesis. Lancet Neurol. 2010;9:425–37.
  • 17. Behzad-Behbahani A, Klapper PE, Vallely PJ, Cleator GM, Bonington A. BKV-DNA and JCV-DNA in CSF of patients with suspected meningitis or encephalitis. Infection. 2003;31:374–8.
  • 18. Bogdanovic G, Priftakis P, Hammarin A-L, Söderström M, Samuelson A, Lewensohn-Fuchs I, et al. Detection of JC virus in cerebrospinal fluid (CSF) samples from patients with progressive multifocal leukoencephalopathy but not in CSF samples from patients with herpes simplex encephalitis, enteroviral meningitis, or multiple sclerosis. J Clin Microbiol. 1998;36:1137–8.
  • 19. Akkaya O, Güvenç Hİ, Güzelant A, Kaya M, Yüksekkaya Ş, Opuş A, ark. Menenjit Etkenlerinin Real-time PZR Yöntemiyle Araştırılması. Türk Mikrobiyol Cem Derg 2017;47(3):131-37.
  • 20. Sarinoğlu RC, Sağlık İ, Mutlu D, ve ark. Beyin Omurilik Sıvısı Örneklerinden Saptanan Viral Etkenler. Türk Mikrobiyol Cem Derg. 2016; 6(4):152-158
  • 21. Soylar M, Altuğlu İ, Sertöz R, ve ark. Ege Üniversitesi Hastanesi’ne başvuran santral sinir sistemi enfeksiyonu olgularında saptanan viral etkenler. Ege Tıp Dergisi. 2014; 53(2):65-70.
  • 22. Çaycı YT, Daştan MSE, Vural DG, Bilgin K, Birinci A. Menenjit Etkenlerinin Araştırılması. J Biotechnol and Strategic Health Res. 2021;5(2):98-104.
  • 23. Aldriweesh MA, Shafaay EA, Alwatban SM, Alkethami OM, Aljuraisi FN, Bosaeed M, Alharbi NK. Viruses Causing Aseptic Meningitis: A Tertiary Medical Center Experience With a Multiplex PZR Assay. Front Neurol. 2020;11:602267.
  • 24. Roshdy WH, Kandeil A, Fahim M, Naguib NY, Mohsen G, Shawky S, Abd El-Fattah MM, Naguib A, Salamony A, Shamikh YI, Moawad M, Guindy NE, Khalifa MK, Abbas E, Galal R, Hassany M, Ibrahem M, El-Shesheny R, Asem N, Kandeel A. Epidemiological characterization of viral etiological agents of the central nervous system infections among hospitalized patients in Egypt between 2016 and 2019. Virol J. 2023 Aug 2;20(1):170
  • 25. Kupila L, Vuorinen T, Vainionpaa R, Hukkanen V, Marttila RJ, Kotilainen P. Etiology of aseptic meningitis and encephalitis in an adult population. Neurology. 2006;66:75–80.
  • 26. Mathew S, Al Khatib HA, Al Ansari K, Nader J, Nasrallah GK, Younes NN, Coyle PV, Al Thani AA, Al Maslamani MA, Yassine HM. Epidemiology Profile of Viral Meningitis Infections Among Patients in Qatar (2015-2018). Front Med (Lausanne). 2021;8:663694.
  • 27. Verstrepen WA, Kuhn S, Kockx MM, Van De Vyvere ME, Mertens AH. Rapid detection of enterovirus RNA in cerebrospinal fluid specimens with a novel single-tube real-time reverse transcription-PZR assay. J Clin Microbiol. 2001 Nov;39(11):4093-6. doi: 10.1128/JCM.39.11.4093-4096.2001. PMID: 11682535; PMCID: PMC88492.De Crom S, et al. Prospective comparison of the detection rates of human enterovirus and parechovirus RT-qPZR and viral culture in different pediatric specimens. J Clin Virol. 2013;58(2):449–454. doi: 10.1016/j.jcv.2013.07.017.
  • 28. Kupila L, Vuorinen T, Vainionpäā R, Marttila RJ, Kotilainen P. Diagnosis of enteroviral meningitis by use of polymerase chain reaction of cerebrospinal fluid, stool, and serum specimens. Clin Infect Dis. 2005 Apr 1;40(7):982-7. doi: 10.1086/428581. Epub 2005 Mar 4. PMID: 15824990.
  • 29. Kumar R. Aseptic meningitis: diagnosis and management. Indian J Pediatr. 2005;72(1):57–63. doi: 10.1007/BF02760582.
  • 30. Poplin V, Boulware DR, Bahr NC. Methods for rapid diagnosis of meningitis etiology in adults. Biomark Med. 2020;14(6):459–479.
  • 31. Aladağ Çiftdemir N, Duran R, Vatansever Özbek Ü, Hançerli Törün S, Acunaş B, Ünal Şahin N. Meningokoksemi: aynı coğrafyada farklı serotipler. Mikrobiyol Bul 2020;54(1):163-170.
  • 32. Beckham JD, Tyler KL, editors. Encephalitis. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseasea, 7th ed. 2010, 1244.
Toplam 32 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Mikrobiyoloji
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Burak Ezer 0000-0003-1217-2080

Mehmet Özdemir 0000-0002-9316-771X

Proje Numarası -
Yayımlanma Tarihi 27 Şubat 2025
Gönderilme Tarihi 6 Ekim 2024
Kabul Tarihi 10 Şubat 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 47 Sayı: 2

Kaynak Göster

Vancouver Ezer B, Özdemir M. Bir Üniversite Hastanesinde Menenjit Ön Tanılı Hastalarda HSV-1, HSV-2, VZV, EBV, CMV, HHV-6 ve HHV-7 Etkenlerinin Araştırılması. Osmangazi Tıp Dergisi. 2025;47(2):271-6.


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