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.