Table 2.
Clinical features and initial investigations by virus
| Adenovirus (n=42) | Cytomegalovirus (n=12) | Enterovirus (n=8) | Herpes simplex virus 1 (n=8) | Human herpes virus 6 (n=16) | Mumps virus (n=29) | Rabies virus (n=14) | Other virus (n=14)* | No virus (n=380) | ||
|---|---|---|---|---|---|---|---|---|---|---|
| Characteristics | ||||||||||
| Male sex | 22 (52%) | 7 (58%) | 6 (75%) | 7 (88%) | 12 (75%) | 15 (52%) | 11 (79%) | 8 (57%) | 193 (51%) | |
| Age (months) | 15 (6–48) | 12 (3–15) | 21 (9–26) | 27 (16–51) | 24 (9–42) | 30 (7–78) | 84 (72–132) | 36 (13–72) | 23 (8–48) | |
| Seizures | 19 (45%) | 5 (42%) | 3 (38%) | 3 (38%) | 9 (56%) | 8 (28%) | 6 (43%) | 10 (71%) | 141 (37%) | |
| Unconsciousness | 3 (7%) | 4 (33%) | 1 (13%) | 3 (38%) | 7 (44%) | 8 (28%) | 5 (36%) | 6 (43%) | 84 (22%) | |
| Fever ≥3 days | 16 (38%) | 1 (8%) | 3 (38%) | 3 (38%) | 6 (38%) | 10 (34%) | 0 | 6 (43%) | 143 (38%) | |
| Vomiting | 3 (7%) | 1 (8%) | 1 (13%) | 4 (50%) | 5 (31%) | 4 (14%) | 0 | 1 (7%) | 51 (13%) | |
| Diarrhoea | 4 (10%) | 2 (17%) | 1 (13%) | 0 | 2 (13%) | 1 (3%) | 0 | 1 (7%) | 29 (8%) | |
| Runny nose | 6 (14%) | 2 (17%) | 2 (25%) | 1 (13%) | 3 (19%) | 1 (3%) | 0 | 2 (14%) | 24 (6%) | |
| Headache | 2 (5%) | 0 | 1 (13%) | 3 (38%) | 2 (13%) | 2 (7%) | 0 | 0 | 26 (7%) | |
| Examination | ||||||||||
| Temperature ≥39°C | 3 (7%) | 1 (8%) | 0 | 0 | 1 (6%) | 1 (3%) | 2 (14%) | 1 (7%) | 39 (10%) | |
| Deep coma | 12 (29%) | 6 (50%) | 1 (13%) | 3 (38%) | 7 (44%) | 9 (31%) | 4 (29%) | 5 (36%) | 101 (27%) | |
| Bulging fontanelle | 1 (2%) | 2 (17%) | 0 | 1 (13%) | 3 (19%) | 0 | 0 | 0 | 5 (1%) | |
| Neck stiffness | 2 (5%) | 4 (33%) | 0 | 0 | 1 (6%) | 1 (3%) | 4 (29%) | 1 (7%) | 26 (7%) | |
| Abnormal chest | 6 (14%) | 2 (17%) | 1 (13%) | 1 (13%) | 2 (13%) | 0 | 0 | 2 (14%) | 12 (3%) | |
| Hepatomegaly | 4 (10%) | 1 (8%) | 2 (25%) | 3 (38%) | 3 (19%) | 2 (7%) | 0 | 1 (7%) | 39 (10%) | |
| Splenomegaly | 3 (7%) | 0 | 1 (13%) | 3 (38%) | 2 (13%) | 3 (10%) | 0 | 1 (7%) | 41 (11%) | |
| Hepatosplenomegaly | 3 (7%) | 0 | 1 (13%) | 2 (25%) | 2 (13%) | 1 (3%) | 0 | 1 (7%) | 27 (7%) | |
| Flexor posturing | 0 | 1 (8%) | 0 | 0 | 2 (13%) | 2 (7%) | 0 | 0 | 4 (1%) | |
| Extensor posturing | 0 | 0 | 0 | 0 | 1 (6%) | 1 (3%) | 0 | 0 | 4 (1%) | |
| Opisthotonus | 1 (2%) | 1 (8%) | 0 | 0 | 0 | 0 | 0 | 0 | 10 (3%) | |
| Observed seizure | 5 (12%) | 0 | 0 | 0 | 2 (13%) | 0 | 1 (7%) | 1 (7%) | 12 (3%) | |
| Investigations | ||||||||||
| CSF opening pressure ≥230 cm | 0 | 1 (8%) | 0 | 0 | 1 (6%) | 0 | 2 (14%) | 0 | 4 (1%) | |
| CSF white cell count >5 per μL | 11 (26%) | 1 (8%) | 4 (50%) | 2 (25%) | 0 | 11 (38%) | 2 (14%) | 8 (57%) | 149 (39%) | |
| HIV status | ||||||||||
| Positive | 0 | 2 (17%) | 1 (13%) | 0 | 2 (13%) | 2 (7%) | 0 | 2 (14%) | 40 (11%) | |
| Negative | 11 (26%) | 1 (8%) | 1 (13%) | 0 | 7 (44%) | 7 (24%) | 0 | 3 (21%) | 61 (16%) | |
| Not known | 29 (69%) | 6 (50%) | 5 (63%) | 0 | 6 (38%) | 19 (66%) | 14 (100%) | 10 (71%) | 284 (75%) | |
| Malaria parasitaemia and CNS virus | 11 (26%) | 3 (25%) | 0 | 2 (25%) | 5 (31%) | 7 (24%) | 5 (36%) | 8 (57%) | .. | |
| CNS virus but no malaria parasitaemia | 26 (62%) | 5 (42%) | 5 (63%) | 5 (63%) | 7 (44%) | 19 (66%) | 9 (64%) | 6 (43%) | .. | |
| Outcome | ||||||||||
| Sequelae | 4 (10%) | 2 (17%) | 2 (25%) | 0 | 2 (13%) | 3 (10%) | 0 | 2 (14%) | 39 (10%) | |
| Died | 11 (26%) | 10 (83%) | 3 (38%) | 1 (13%) | 1 (6%) | 5 (17%) | 14 (100%) | 3 (21%) | 46 (12%) | |
Data are n (%) or median (IQR). 11 patients (not shown here) had dual virus infections; each patient had a different combination of viruses: adenovirus in five cases, human herpes virus in four, cytomegalovirus in four, enterovirus in three, mumps in three, herpes simplex virus in one, measles in one, and parvovirus in one. Genotyping indicated that seven of the adenoviruses detected were members of subgroup B, one was subgroup C. Median age of patients with dual infection was 18 months (IQR 15–26), and Blantyre coma score on admission 3 (2–5). Seven patients with dual infection had malaria parasitaemia, three were HIV positive (of five tested), and three had a CSF pleocytosis.·Six children (55%) with dual viral infections died. CSF=cerebrospinal fluid.
Epstein-Barr virus (five patients), parvovirus (five), human herpes virus 7 (two), measles (one), JC/BK virus (one).