Laboratory diagnosis of CNS infections in children due to emerging and re-emerging neurotropic viruses.

Dec 04, 2023

Experts: Benjamin M Liu,Sarah B Mulkey,Joseph M Campos,Roberta L DeBiasi

Recent decades have witnessed the emergence and re-emergence of numerous medically important viruses that cause central nervous system (CNS) infections in children, e.g., Zika, West Nile, and enterovirus/parechovirus. Children with immature immune defenses and blood-brain barrier are more vulnerable to viral CNS infections and meningitis than adults. Viral invasion into the CNS causes meningitis, encephalitis, brain imaging abnormalities, and long-term neurodevelopmental sequelae. Rapid and accurate detection of neurotropic viral infections is essential for diagnosing CNS diseases and setting up an appropriate patient management plan. The addition of new molecular assays and next-generation sequencing has broadened diagnostic capabilities for identifying infectious meningitis/encephalitis. However, the expansion of test menu has led to new challenges in selecting appropriate tests and making accurate interpretation of test results. There are unmet gaps in development of rapid, sensitive and specific molecular assays for a growing list of emerging and re-emerging neurotropic viruses. Herein we will discuss the advances and challenges in the laboratory diagnosis of viral CNS infections in children. This review not only sheds light on selection and interpretation of a suitable diagnostic test for emerging/re-emerging neurotropic viruses, but also calls for more research on development and clinical utility study of novel molecular assays. IMPACT: Children with immature immune defenses and blood-brain barrier, especially neonates and infants, are more vulnerable to viral central nervous system infections and meningitis than adults. The addition of new molecular assays and next-generation sequencing has broadened diagnostic capabilities for identifying infectious meningitis and encephalitis. There are unmet gaps in the development of rapid, sensitive and specific molecular assays for a growing list of emerging and re-emerging neurotropic viruses.
© 2023. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.

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ABOUT THE EXPERTS

Benjamin M Liu,Sarah B Mulkey,Joseph M Campos,Roberta L DeBiasi

Benjamin M Liu

Division of Pathology and Laboratory Medicine, Children’s National Hospital, Washington, DC, USA. bliu1@childrensnational.org.

Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA. bliu1@childrensnational.org.

Department of Pathology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA. bliu1@childrensnational.org.

Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA. bliu1@childrensnational.org.

Children’s National Research Institute, Washington, DC, USA. bliu1@childrensnational.org.

The District of Columbia Center for AIDS Research, Washington, DC, USA. bliu1@childrensnational.org.

Sarah B Mulkey

Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

Children’s National Research Institute, Washington, DC, USA.

Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC, USA.

Division of Neurology, Children’s National Hospital, Washington, DC, USA.

Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

Joseph M Campos

Division of Pathology and Laboratory Medicine, Children’s National Hospital, Washington, DC, USA.

Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

Department of Pathology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

Roberta L DeBiasi

Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA. rdebiasi@childrensnational.org.

Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA. rdebiasi@childrensnational.org.

Children’s National Research Institute, Washington, DC, USA. rdebiasi@childrensnational.org.

Division of Pediatric Infectious Diseases, Children’s National Hospital, Washington, DC, USA. rdebiasi@childrensnational.org.