Co-detection of Human Herpes Viruses in Cerebrospinal Fluid Samples of Pediatric Patients with Multi-System Inflammatory Syndrome: A Single Center Experience in Isfahan, Iran

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Background: Since December 2019, the Coronavirus disease 2019 (COVID-19) pandemic has impacted the world, including neurologic manifestations among its effects. Additionally, some studies have reported the reactivation of various viruses in patients diagnosed with COVID-19. Objectives: This study aimed to investigate the viral infection patterns of common viruses that cause encephalitis in patients diagnosed with the concurrence of multi-system inflammatory syndrome in children (MIS-C) and encephalitis. Methods: This cross-sectional study was conducted from February 2020 to May 2021. Children diagnosed with both MIS-C and encephalitis were included. Cerebrospinal fluid (CSF) samples were collected from each participant for a biochemistry panel and polymerase chain reaction (PCR) assays for varicella-zoster virus (VZV), cytomegalovirus (CMV), herpes simplex virus (HSV), Epstein-Barr virus (EBV), adenovirus, and influenza virus. Furthermore, patients underwent neuroimaging studies, including magnetic resonance imaging and computed tomography. Results: Thirteen patients with MIS-C and encephalitis were enrolled. Viral detection in CSF samples through PCR assays was successful in six patients. EBV and HSV were detected in four and two patients, respectively. The median age of these six children was 44 months, with four being male. Follow-up visits after six months showed that their quality of life had returned to normal. Conclusions: This study highlighted the co-occurrence of HSV and EBV reactivation with MIS-C. Although viral reactivations, unlike primary infections, resolved spontaneously in our cohort. Consequently, the reactivation of viruses due to MIS-C may open new avenues for future research.

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