Herpesviruses, enteroviruses, and arboviruses are important because of their clinical relevance and ability to cause meningitis, encephalitis, meningoencephalitis, and other diseases. The clinical virology associated with diagnostic technologies can reduce the morbidity and mortality of such neurological manifestations. Here we aimed to identify the genomes of agents that cause neurological syndromes in cerebrospinal fluid (CSF) samples from patients with suspected nervous system infections admitted to the University Hospital of the University of Campinas, São Paulo, Brazil, in 2017-2018. CSF samples collected from adult patients with neurological syndrome symptoms and negative CSF culture results were analyzed using polymerase chain reaction (PCR), reverse transcriptase-PCR, and real-time PCR, and their results were compared with their clinical symptoms. One CSF sample was obtained from each patient. Viral genomes were detected in 148/420 (35.2%) CSF samples: one of 148 (0.2%) was positive for herpes simplex virus-1; two (0.5%) for herpes simplex virus-2; eight (1.9%) for varicella-zoster virus; four (1%) for Epstein-Barr virus; one (0.2%) for cytomegalovirus; 32 (7.6%) for human herpesvirus-6; 30 (7.1%) for non-polio enterovirus; 67 (16.0%) for dengue virus, three (0.7%) for yellow fever virus, and 21 (5%) for Zika virus. The viral genomes were found in 35.2% of all analyzed samples, showing the high prevalence of viruses in the nervous system and the importance of using a nucleic acid amplification test to detect viral agents in CSF samples.

The risk of infection transmission from mother to fetus depends on the pathogen. TORCH agents cause some neuroinfections, including Toxoplasmosis, rubella, Cytomegalovirus, herpes simplex 1 and 2, and others (Varicella Zoster, Parvovirus B-19, Epstein–Barr virus, and Zika virus). The consequences can be stillbirth, prematurity, uterine growth restriction, and congenital malformations. The detection of DNA/RNA from CSF by molecular methods is a marker of the involvement of congenital infection in the central nervous system. This study aimed to identify the frequency of these pathogens in CSF samples from newborns (1 to 28 days old) at a tertiary hospital, using PCR, and determine the clinical consequences. Methods: This was a prospective descriptive study involving the molecular analysis of 151 CSF samples from neonates, collected for cytological and biochemical diagnosis from 2017 to 2021. After the results and consent from the participants’ caregivers were obtained, the leftover material was sent to the University’s Virology Laboratory and submitted for DNA/RNA extraction and Nested-PCR/RT-PCR. A review of the patients’ medical records and descriptive statistics was performed. This work was approved by the Ethics Committee (CAAE: 86760218.3.0000.5404). Results: A total of 151 CSF samples were obtained, 16 of which were positive (10.6% [95% CI%: 6.18–16.63%]). Two of these were PCR-positive for HSV-1 (1.3%), four for VZV (2.6%), one for CMV (0.67%), two for Toxoplasmosis (1.3%), four for Parvovirus B-19 (2.6%), and four for Zika (2.6%). The proportion of positive PCR results was higher in the group that presented with malformations (25.0% vs. 8.4%, p = 0.040). Conclusions: The pathogens identified by PCR were mostly Zika virus, VZV, and B-19, and these were mainly found in newborns with malformations.

Since the significance of viral infections in children and adolescents with nephrotic syndrome (NS) is yet to be defined, this study intended to estimate the occurrence, pattern, and outcomes of some DNA viral infections in children with NS. Methods: A prospective study was conducted to determine the genome identification of the viruses Epstein-Barr (EBV), human cytomegalovirus (HCMV), human herpesvirus 6 (HHV-6 type A and type B) and 7 (HHV-7), polyomavirus (BKV), and human adenovirus (HAdV) in plasma and urine samples of pediatric patients with NS. Results: A total of 35 patients aged 1 to 18 years with NS and under immunosuppressant drugs participated in the study. Plasma and urine samples were collected at regular intervals during a median follow-up of 266 days (range 133–595), and DNA was analyzed to detect the selected DNA viruses. Eleven patients (31.4%) had active virus infections, and patterns were classified as coinfection, recurrent, and consecutive. Of these, six patients (54.5%) presented viral coinfection, six (54.5%) viral recurrence, and seven patients (63.3%) had viral consecutive infection. Ten of the eleven patients with active infection had a proteinuria relapse (91%) and eight (72.7%) were hospitalized (p = 0.0022). Active HCMV infection was the most frequent infection and was observed in six patients (54.5%), three of the eleven patients (27.2%) had suspected HCMV disease in the gastrointestinal tract, and one had HHV-7 coinfection. The frequency of other infections was: 9% for HHV-6, 45.5% for BKV, 27.3% for HHV-7, 18.2% for EBV, and 18.2% for HAdV. Conclusion: viral infections, especially HCMV, can be an important cause of morbidity and nephrotic syndrome relapse in children.

Objective. To investigate the presence of arbovirus genomes in cerebrospinal fluid (CSF) samples from children suspected of viral neurological infection, associating the results with clinical manifestations and analyzing the CSF. Methods. The cross-sectional study included CSF samples from 184 children and teenagers aged 1 day to 18 years old, with negative CSF microbiology tests. Molecular tests were carried out to detect arboviruses in the CSF. Results. Among 184 children, the genome of dengue (DENV) and zika (ZIKV) viruses were found in 44 CSF samples (23.9%) (CI 95% 17.7%-30.1%). Among those samples, 59% were positive for dengue virus, 38.6% for ZIKV, and 2.3% coinfection of DENV plus ZIKV was observed. In 67 patients with suspected infection/sepsis, 23.9% of CSF samples were positive; among 26 meningitis, 11.5% had positive results; in 22 hydrocephaly, 22.7% were positive; in 20 with convulsion, 25% had CSF positive, in 4 with encephalitis 25% were positive; in 5 intracranial hypertension, 60% were positive; 1 in 3 cases, 33.3% each, presented with neuritis and meningoencephalitis were positive; the 2 Guillain-Barré syndrome were positive. Pleocytosis occurred in 25% of positive cases, and antibiotics were used in 56.8%. We found a positivity of neurological infection by ZIKV and DENV in children even after the outbreak. Most positive samples did not show biochemical changes in the CSF. Conclusion. Molecular tests in CSF of children with neurological conditions contribute to the identification of the viral etiology, leading to less use of unnecessary antibiotics and reducing hospital stays.Keywords: arboviruses; dengue; zika; children; molecular detection; central nervous

Detection of ribonucleic acid (RNA) Zika virus in cerebrospinal fluid (CSF) by molecular methods serves as a marker of the involvement of congenital infection in newborns’ central nervous system. This study aims to describe the detection of Zika virus genome in CSF samples from newborns (aged from one to 28 days) using molecular biology and its clinical consequences following the Zika virus epidemic from October 2015 to May 2017, in Brazil. This prospective descriptive study molecularly analyzed 151 CSF samples from neonates at Professor Doutor Jose Aristodemo Pinotti Hospital, collected for cytological and biochemical diagnosis from June 2017 to June 2021. After the consent of legal guardians, signing of free and informed consent forms, and the issuance of these results, the remaining CSF was sent to the Virology Laboratory of School of Medical Sciences in the State University of Campinas (Unicamp) and was subjected to RNA extraction and real-time polymerase chain reaction (RT-PCR). A review of patients’ medical records and descriptive statistics were also performed. This study obtained 151 CSF samples, four of which were PCR positive for Zika virus (2.6%, with two presenting congenital malformations). These results suggest the clinical relevance of etiological diagnosis of congenital Zika syndrome by molecular biology in newborns’ CSF samples even after the Zika virus epidemic (which occurred from October 2015 to May 2017) in Brazil.