Identification of Viral Causes in Cerebrospinal Fluid of Patients Under Investigation for Central Nervous System Infections During the COVID-19 Epidemic: A Cross-Sectional Study

Background: Although viral etiology of central nervous system (CNS) infections such as meningitis and encephalitis are investigated widely worldwide, it remains to be declared under the COVID-19 pandemic. Objectives: The focus of this study was to examine the etiology of viral CNS infections in patients hospitalized in a single referral hospital during the outbreak in Iran. Methods: We retrospectively collected the cerebrospinal fluid (CSF) samples and reviewed the medical records of patients hospitalized with suspected viral CNS infection in Shiraz, a large city in southern Iran, from April 2021 to May 2022. One hundred sixty-six CSF samples were tested primarily for detection of HSV-1 and -2 and retrospectively analyzed by primers polymerase chain reaction (PCR) targeted to coronavirus 2 (SARS-CoV-2), human herpesviruses1 to 6 (HHV-1 to 6), polyomaviruses JC, and enteroviruses (EV). Results: Of the total CSF samples analyzed by PCR, 22 (13.3%) were positive for only one viral pathogen, and just one (0.6%) sample was detected with multiple viruses (HSV-1 and CMV). The SARS-CoV-2 (6 cases) was the second most common viral etiology just after Herpes simplex virus-1 (HSV-1) 6.6% (11 cases). Other detected viruses were CMV for 1.8% (3 cases), VZV for 1.2% (2 cases), and JC for 0.6% (1 case) of the cases. Conclusions: This study highlights the prevalence of viral pathogens in CSF samples from patients with suspected meningitis at Namazi Teaching Hospital. Notably, HSV-1 was the most common virus detected, followed by SARS-CoV-2. These findings underscore the importance of viral testing in the diagnosis and management of meningitis.