Tehran University Medical Journal

---

Background: In recent years, many ill cases with cytomegalovirus reactivation in non-immuno compromised persons reported. Goal of study: to determine the CMV infection in cerebrospinal fluid of aseptic meningoencephalitis children hospitalized in Rasul & Mofid hospital (2005-2007).

Methods: In a cross sectional study 132 cases selected with simple sampling. CMV-DNA in their Cerebro spinal fluids searched by qualitative PCR.

Results: The age range of the study patients was 5 month- 13 years, median age= 2±3.7 years 87(65.9%) male and 45(34.1%) was female. The presenting signs and symptoms were convulsion 77(69.4%) meningitis 25(18.8%), loss of consciousness 47(37%) neurologic defects 15.9%. DNA extrated in 11 cases. Mycoplasma- DNA in 2cases DNA-CMV detected 2(1.5%). Positive DNA HSV found in 7(15.3%) of patients. DNA- HSV type- 15.3% (7/132) cases. An infant 5 month age with developmental delay, microcephaly and recurrent convulsions. A 1 year girl with brain atrophy and progressive hydrocephaly with intracranial shunt

Conclusions: Differentiation between herpes meningoencephalitis and other encephalopathy based on clinical signs in children is too difficult. CMV (1.5%) has lower rate than herpes simplex type-1 (5.7%). In addition to CMV and HSV1 all of herpes family viruses (varicella, herpes 6, 7, Epstein barr virus) could have role in  children with meningoencephalitis. In recent years a sensitive, rapid, simple diagnostic  test "Single tube Multiplex PCR" in cerebro spinal fluid recommend. Rapid diagnosis and faster treatment is necessary for decreasing mortality and morbidity in all of herpes meningoencephalitis cases

---

Background: M. pneumoniae infection in children is usual and diagnosis of its neurologic complications for rapid treatment is very important. To compare the CSF- M. pneumoniae antibody level between febrile children with acute neurologic signs (Menigoencephalitis, Guillan Barre Syndrome (GBS), Transverse myelitis, Ataxia and so on) with unaffected ones.

Methods: A cross sectional/ case control study in pediatric wards of Rasoul-e-Akram & Mofid hospitals (2007-2009) was done. The amount of Specific M. pneumoniae IgG (ELISA) antibody level determined in CSF of 55 cases and in 10 controls. Chi square values (CI 95%, p< 0.05) calculated for all categorical variables. Sensitivity specificity Positive Predictive Value (PPV) Negative Predictive Value (NPV) of CSF antibody level determined by using the Area under the ROC Curve.

Results: Cases (n= 55) aged between five month to 13 years with mean age of 3.84±3.43 years. Area Under Curve (AUC) in ROC was 0.876 (%95 CI, 0.78- 0.96 p< 0.0001). Cut off level for antibody was 0.0025 with 73% sensitivity 90% specificity 100% PPV 28.8% NPV. CSF antibody level had significant difference between cases and controls [0.08± 0.26 Versus 0.001± 0.001 p: 0.02] It had poor agreement between cases and controls (Kappa= 0.27). Lowest amount seen in cases with aseptic meningitis highest amount observed in cases with GBS and cases with focal neurologic signs.

Conclusion: The presence of very low amount (0.0025) of M. pneumoniae antibody in CSF of febrile children with acute neurologic signs had 70% sensitivity and 90% specificity 100% PPV but had low (28.8%) NPV. M. pneumoniae would be a rare cause in cases with aseptic meningitis. Finding the M. pneumoniae-DNAs in CSF are not so frequent (2%) but in high suspicious cases adding this test to determining the CSF antibody level might be helpful.