北京儿童医院下呼吸道感染住院患儿血清腺病毒抗体检测分析

目的了解北京儿童医院急性下呼吸道感染住院患儿的腺病毒（ADV）感染情况。方法研究对象为北京儿童医院2004年10月至2005年12月临床诊断为肺炎或支气管炎的住院患儿。每例患儿的血清标本采用间接酶联免疫吸附试验检测ADV—IgM抗体。如果任意一种其他病毒抗体阳性（包括巨细胞病毒、EB病毒、单纯疱疹病毒、肠道病毒等），则不做ADV检测。结果738例其他病原检测阴性的下呼吸道住院患儿中，ADV—IgM阳性87例，阳性率11．8％。ADV下呼吸道感染占同期病例的8．3％（87／1046）。其中〈1岁的患儿32例（6、2％）；1～6岁42例（29、8％）；〉6岁13例（16．9％）。ADV感染全年散发，冬春季节相对较多。结论ADV是5岁以下儿童急性呼吸道疾病的主要病原之一；6月龄至3岁的儿童为易感人群。     

Clinical picture of Herpesviridae infections among immunocompromised patients: bone marrow and solid organ transplants recipients

The human herpes virus (HHV) family (herpesviridae) are large DNA viruses containing eight important, ubiquitous human pathogens. This group of viruses encompasses: herpes simplex virus (HSV types 1 and 2), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), HHV-6, HHV-7 (cause roseola or exanthema subitum in children) and Kaposi sarcoma herpes virus--(KSHV). The outstanding property of herpes viruses is lifelong persistence of infection and potential periodic reactivation, particularly often among immunocompromised patients. Herpesvirus infections are associated with a wide spectrum of diseases ranging from local ulceration to serious systemic illnessess or malignancies. These infections are one of the major cause of morbidity and mortality in the immunocompromised patients.     

2879例血清标本常见6种病毒联合检测结果的初步分析

目的了解长沙地区人群对EBV、COXV、ADV、RSV、CMV及HSV-Ⅰ 6种常见病毒的IgM抗体感染情况.方法采用ELISA法,对2002年10月～2004年10月期间2 879例湘雅医院门诊及住院患者血清进行了6种病毒的特异性IgM抗体联合检测. 结果EBV、COXV、ADV、RSV、CMV、HSV-Ⅰ的阳性率分别为8.58%、5.70%、1.63%、2.92%、5.73%、4.10%,其中EBV明显比其它病毒感染阳性率高(P＜0.05).每年夏秋COXV、CMV与HSV-Ⅰ相对该病毒其它季节感染率明显高(P＜0.05),EBV感染无明显季节差异(P＞0.05),秋冬季RSV感染率、秋季ADV感染率也比该病毒其它季节明显增高(P＜0.05).EBV在青少年儿童中感染率和COXV在青春期及成年人感染率均比该病毒其它年龄组高(P＜0.05),而ADV、RSV、CMV及HSV-Ⅰ在各年龄段中感染率无明显差异(P＞0.05). 结论长沙地区人群对这6种病毒的感染程度存在季节和年龄差异.应该根据不同季节、针对不同人群采取不同的预防措施.     

关于对本刊统一使用"结核分枝杆菌"名称的建议

分枝杆菌属（Mycobacterium）是一类细长或稍弯的杆菌，因有分枝生长的趋势而得名。Lehmann和Neumann在1896年第一次建立了“Mycobacterium”一词。结核分枝杆菌（Mycobacterium tuberculosis）是引发人类结核病的病原菌。根据词义和细菌形态学特点，     

化学发光免疫分析法在检测儿童EB病毒感染中的应用

目的 探讨化学发光免疫分析法检测EB病毒抗体在儿童临床EB病毒(EBV)感染诊断中的价值.方法 对228例符合EB病毒感染诊断标准的患儿采用化学发光免疫分析法检测血浆样本中VCA-IgM、EA-IgG、EBNA-IgG、VCA-IgG含量.结果 血浆VCA-IgM、EA-IgG、EBNA-IgG、VCA-IgG的检出率分别为84.65％、20.61％、25.88％、76.75％,差异具有统计学意义(P＜0.05);各种抗体以不同组合方式出现VCA-IgM阳性分类中,以VCA-IgM+VCA-IgG组合模式最为多见,VCA-IgM阴性分类中,则以VCA-IgG+EBNA-IgG组合模式最为多见;不同年龄段儿童VCA-IgM的检出率差异有统计学意义(P＜0.05),初次感染的年龄段主要集中在0～3岁.结论 化学发光免疫分析法检测EB病毒抗体对儿童EB病毒感染的明确具有早期、全面、快速等优点,适合临床检测.     

Infections due to the human herpesviruses in southern India: a seroepidemiological survey

We studied the prevalence of IgG and IgM antibodies to the human herpesviruses in a hospital-based population of 181 individuals aged 0 to 25 years, who were resident in Vellore, south India or surrounding rural areas. Antibodies to the Epstein-Barr virus (EBV) viral capsid antigen were determined by indirect immunofluorescence, while antibodies to the remaining herpesviruses were determined by enzyme-linked immunosorbent assay. The age-specific prevalence rates of IgG antibodies to EBV and cytomegalovirus (CMV) rose rapidly after birth to reach a value of over 90% by the fourth year of life. High age-specific IgM prevalence rates and geometric mean titres (GMT) of IgG antibody in children 6 months to 2 years of age, and the early median age of virus infection (1.4 years for EBV and less than 1 year for CMV) indicate that primary infection with these viruses occurs early in life. In contrast, age-specific prevalence rates of IgG antibodies to varicella-zoster virus (VZV) and herpes simplex virus (HSV) rose gradually after birth to attain maximal values of only 72% (VZV) and 83% (HSV) in the 15-25 year age group, and the median ages of infection were delayed (12.25 years for VZV and 8.2 years for HSV). The age-specific IgG prevalence rates of VZV and HSV, and of EBV and HSV showed statistically significant positive correlations, suggesting that common epidemiological factors may underlie the pattern of infections due to these groups of viruses.(ABSTRACT TRUNCATED AT 250 WORDS)     

纤维支气管镜及支气管肺泡灌洗检查对免疫功能低下合并肺炎病原学诊断价值

目的探讨纤维支气管镜及支气管肺泡灌洗(BAL)对免疫功能低下合并肺炎病原学诊断的意义。方法回顾分析近年来医院免疫功能低下合并肺炎行纤维支气管镜检查的36例患者的临床资料,及纤维支气管镜检查和支气管肺泡灌洗液(BALF)病原学检查结果。结果经纤维支气管镜和(或)BAL检测61.1%的患者可确定感染病原体,同时进行外周血和BALF巨细胞病毒(CMV)定量PCR检测19例,阳性率分别为14.3%和42.9%(P<0.05),同时行BALF CMV定量PCR和外周血CMV IgM检测15例,阳性率分别为47.1%和5.9%(P<0.05);经各种方法诊断CMV肺炎共9例,其中8例经BALF中CMV定量PCR检测确定,经纤维支气管镜取分泌物或BALF培养总阳性率50.0%;同时行分泌物和BALF培养的患者中,分泌物和BALF真菌培养阳性率分别为14.3%和42.9%,细菌培养阳性率均为28.6%,1例患者BALF检测卡氏肺囊虫阳性。结论纤维支气管镜及支气管肺泡灌洗对免疫功能低下合并肺炎的病原学诊断有较高价值,有助于早期明确诊断和指导治疗。     

Viral etiology of obscure splenomegaly in Egyptian children

Fifty seven Egyptian children aged 1.5 to 9.5 years with mild splenomegaly (less than 3 cm below the costal margin) were screened for antibodies against the three common viruses of the Herpes group: Cytomegalovirus (CMV), Epstein-Barr (EB) and Herpes type 1 virus. A group of 57 healthy children were studied similarly. All patients were subjected to a comprehensive laboratory and clinical work up to exclude any hematological, metabolic or malignant etiology for the splenomegaly. Splenic aspirates from five cases were examined histologically and by immunohistochemistry for the antigens of CMV. Only primary or reactivation of CMV might be considered a cause of splenomegaly, as there was a statistically significant increase in the prevalence of IgM antibodies to CMV in the patients compared to normal controls (63% of patients and 19.4% of controls had IgM antibodies, P less than 0.001; 68.3% of patients and 54% of controls had IgG antibodies, P is insignificant). An almost equal proportion of children with and without splenomegaly had antibodies to EB-Viral Capsid Antigen (EBVCA) both IgG and IgM. (28% of cases and 33% of controls had IgM antibodies; 26% of patients and 21% of controls had IgG antibodies). A role of Epstein-Barr viral infection could not be ruled out in these patients. There was a higher prevalence of antibodies to Herpes type 1 virus in asymptomatic controls than in children with splenomegaly. (10% of patients and 43% of controls had IgM antibodies, 10.6% of patients and 38% of controls had IgG antibodies).     

Seroepidemiology of Epstein−Barr virus and cytomegalovirus among Israeli male young adults

PurposeTo assess the seroprevalence and seroconversion of Epstein?Barr virus (EBV) and cytomegalovirus (CMV) Immunoglobulin G (IgG) antibodies and identify associated socioeconomic and smoking variables among male young adults in Israel, to explore health disparities and aid prevention efforts.MethodsA population-based seroprevalence study of EBV and CMV IgG antibodies in a systematic sample of Israeli males upon recruitment to mandatory military service during 1994–2004. Associations between socioeconomic and smoking variables and the seroprevalence of EBV/CMV were evaluated, controlling for possible confounders. A subset of seronegative subjects was assessed for seroconversion upon discharge from military service.ResultsOverall seroprevalence rates were 87% for EBV and 59% for CMV. An association between the seroprevalence of EBV and CMV was observed. Seroconversion was 56% for EBV as compared with 31% for CMV. Lower paternal education was found to be associated with both EBV and CMV seroprevalence. Lower socioeconomic status, North African origin, and urban residence were found to be associated with CMV seropositivity, as was smoking for EBV seropositivity.ConclusionsSocioeconomic disparities exist in the seroprevalence rates of CMV and EBV among Israeli male young adults. The results of the study could aid public health efforts and determine target populations when a vaccine becomes available.     

Étude comparative des primo-infections à Epstein-Barr virus et à cytomégalovirus chez 52 patients immunocompétents

Objective

The objective of this study was to compare epidemiological, clinical, and biological data of Epstein-Barr virus (EBV) and cytomegalovirus (CMV) primary infections in immunocompetent adults, admitted in the infectious disease department of the Reims Teaching Hospital between 2000 and 2005.

Patients and methods

Inclusion criteria were the presence of anti-VCA IgM antibodies or the presence of CMV specific IgM antibodies and the absence of any other positive serology. Differences in reported percentage were compared with a Khi² test or Fischer's exact test, when appropriate. Continuous variables were compared with the Mann-Whitney Test.

Results

There were no significant changes over the years in the numbers of EBV (n = 32) and CMV (n = 20) primary infections. The patient's mean age was 22.7 years (14-48 years) in EBV primary infections and 38.6 years (13-66 years) in CMV primary infections (P < 0.01). The clinical variables significantly associated with primary EBV infection were sore throat and cervical lymphadenopathy (P < 0.01). Arthromyalgia and respiratory manifestations were less frequent in EBV primary infection (P < 0.01). The biological variables significantly associated with EBV primary infection were a marked alanine aminotransferase elevation and a marked lymphocytosis with atypical lymphocytes (P < 0.001). Thrombopenia was less frequently associated with EBV primary infection (P < 0.001).

Conclusion

Clinical and biological presentations of EBV and CMV primary infections were similar. The simultaneous serologic diagnosis of these two infections remains necessary to provide a specific diagnosis, for the most efficient patient care.     

Non-A, non-B viral hepatitis in Egypt.

A study was carried out on 200 patients of ages 20-40 years suffering from acute viral hepatitis. Sera were tested for markers of hepatitis B (HBsAg, and IgM anti-HBc) and hepatitis A (IgM-anti-HAV) by the ELISA technique. Sera negative for the markers of both viruses: Hepatitis A (HAV) and Hepatitis B (HBV) were subsequently tested for IGM Heterophil antibodies against Epstein-Barr virus (EBV) by the Monospot slide test to diagnose acute infectious mononucleosis and tested for anti-CMV (IgM) by ELISA technique for the diagnosis of acute Cytomegalovirus (CMV) infection. Non-A, non-B hepatitis (NANB) was diagnosed by exclusion. The results of the study showed that 133 (66.5%) patients had evidence of HBV infection, while only 9(4.5%) were diagnosed as HAV infection. EBV and CMV were the possible etiological agents of acute viral hepatitis in (3.5%) and 1%) respectively. Accordingly the Non-A, non-B hepatitis in this study amounts to (24.5%) of the acute viral hepatitis.     

Rapid shell vial culture for the detection of respiratory viruses from bronchoalveolar lavage in immunocompromised patients

AIM: Viral lower respiratory tract infections (LRTI) are an important cause of morbidity in immunocompromised patients. The aim of this study was to evaluate the clinical impact of rapid shell vial cultures from bronchoalveolar lavage (BAL). METHODS: Sixty-seven BAL samples from 46 patients have been retrospectively examined: 51 from 31 transplant recipients and 16 from 15 immunocompromised patients. BAL were inoculated on human embryonic lung fibroblasts and VERO cells to isolate the following viruses: cytomegalovirus (CMV), herpesviruses, varicella-zoster virus, respiratory syncytial virus, adenovirus, Influenza viruses A and B and Parainfluenza viruses. Clinical, microbiological, laboratory, and radiological data were collected. RESULTS: A LRTI was present in 56.7% of cases: viral 40.3%, bacterial and/or fungal 23.9%, and mixed 7.5%. CMV accounted for 92.6% of viral LRTI. The prevalence of viral infections did not differ between symptomatic and asymptomatic patients; only bacterial and/or fungal infections were significantly more prevalent in symptomatic patients. No clinical, radiological or laboratory feature was significantly associated with the presence of a viral LRTI. In lung transplant recipients the rate of CMV infection was 50%. The result of BAL suggested commencement of antiviral chemotherapy in 25/67 episodes. CONCLUSION: Rapid shell vial culture and immunofluorescence techniques from BAL could play an important role in the clinical management of immunocompromised subjects.     

A study of Cytomegalovirus, Epstein-Barr virus and Herpesvirus hominis (types 1 and 2) antibody in institutionalized and non-institutionalized children.

In an attempt to demonstrate differences in antibody prevalence between free-living and institutionalized children, antibodies to Cytomegalovirus (CMV), Epstein-Barr virus (EBV), and Herpesvirus hominis (HVH), types 1 and 2, were assayed in 123 children. The children comprised three groups consisting of 41 institutionalized patients with Down's syndrome (all non-disjunctive trisomy-G karyotype and equal numbers of age-, sex-, and race-matched non-mongoloid institutionalized subjects and non-institutionalized normal controls. CMV antibody titer values were statistically similar in the three groups. However, fewer mongoloids (21.9%) were seropositive than other institutionalized retardates (39.0%) and normal control subjects (43.9%). Antibody titer values to EBV were also similar; however, in comparison to the other groups, significantly more mongoloids were seropositive at younger ages. More mongoloids were seropositive to HVH-1 and had higher antibody titers than the other two groups. Antibody to HVH-2 was more prevalent in institutionalized subjects, 85.4% in mongoloids and 65.8% in other institutionalized retardates, than in normal non-institutionalized children (26.8%).     

宝鸡地区小儿急性下呼吸道感染病毒和肺炎支原体病原学的多中心研究分析

【目的】 了解病毒和肺炎支原体病原在宝鸡地区小儿急性下呼吸道感染(acute lower respiratory infections,ALRI)患儿中的构成特点。 【方法】 收集宝鸡市5家医院2010年8月-2011年7月ALRI住院小儿7 979例的病毒和肺炎支原体病原学检测结果进行汇总分析。 【结果】 小儿ALRI患儿血清7种急性病毒抗体IgM总阳性率为32.7%;阳性率由高到低依次为:EB病毒抗衣壳抗原抗体IgM 7.6%,柯萨奇病毒抗体IgM 7.2%,巨细胞病毒抗体IgM 5.5%,埃可病毒抗体IgM 5.1%,副流感病毒抗体IgM 4.1%,腺病毒抗体IgM 2%,呼吸道合胞病毒抗体IgM 1.2%。肺炎支原体抗体IgM阳性率12.6%。下呼吸道分泌物病原核酸(PCR-荧光探针法)检测阳性率结果为:EB病毒DNA 24.4%,肠道病毒(普通型)RNA 10.7%,呼吸道合胞病毒RNA 4.3%,柯萨奇病毒A 16 3.8%;肺炎支原体核酸定量阳性率为11.7%。 临床最常见的混合感染是EBV和MP混合感染。 【结论】 小儿ALRI病原学分布存在人群、地区和季节、年份等的差异性,病毒和肺炎支原体是宝鸡地区小儿ALRI的重要病原,病毒以EBV为主。应开展多方法、多病原的联合检测。     

The essence of infection by opportunistic microorganisms

Infection is regarded as an imbalance between microbial pathogenicity factors and the host defense systems. Opportunistic infections are defined as infections rarely observed in humans with normal immune responses. The term immunocompromised (compromised) host refers to host in which one or more defence mechanisms are inactive and in which the probability of infection is therefore increased. Hospital patients are often compromised host. Compromised hosts exist even outside the hospital (smoking, intravenous drug use, poor nutrition and other). A good example is HIV (human immunodeficiency virus). HIV causes acquired immunodeficiency syndrome (AIDS) by destroying the CD4 T lymphocytes, involved in the immune response. The most common AIDS-associated opportunistic infections include pneumonia caused by the fungus Pneumocystis carinii, systemic candidiasis (Candida albicans) and cryptococcosis (Cryptococcus neoformans), protozoal infections such as cryptosporidiosis (Cryptosporidium spp.) and toxoplasmosis (Toxoplasma gondii), viral infections due to HSV, CMV, EBV, HPV or HHV8, tuberculosis and other bacterial infections. Pneumocystis carinii pneumonia (PCP) is the most common opportunistic disease observed in AIDS patients. Disease does not necessarily follow exposure to a given causal agent (pathogen 01 opportunistic pathogen). In fact, the occurrence (or otherwise) of disease typically depends on various factors--including the degree of sensitivity of the host (as above) and the virulence factors of the pathogens. Overtly aggressive products such as toxins and aggressins are clearly virulence factors. However, so too are those products and strategies which help a pathogen to become established in the host and to evade the host's defences. Certain virulence factors can be induced in the pathogen via signal transduction pathways from environment.     

小儿反复呼吸道感染的相关因素分析

目的 探讨分析小儿反复呼吸道感染的相关因素.方法 选取医院2008年5月-2010年5月收治的335例反复呼吸道感染患儿设为观察组,选择同期普通病房收治的呼吸道感染患儿335例设为对照组;采集所有患儿的静脉血5 ml,采用酶联免疫吸附试验检测血清EB病毒(EBV)-IgM,采用间接血球凝集法测定肺炎支原体(MP)-IgM,采用中生金域诊断技术有限公司小儿佝偻病诊断人骨碱性磷酸酶(BALP)试剂盒,测定BALP,所有操作严格按试剂盒说明进行,判定标准以试剂盒要求标准为准,每一种测定方法均由固定检验员在同一操作条件下完成.结果 观察组患儿中28.4％、对照组患儿中有11.0％血清中检测出EBV-IgM;观察组患儿中37.0％、对照组患儿中有13.4％血清检测MP-IgM呈阳性;观察组患儿中32.8％、对照组患儿中有6.0％血清检测BALP呈阳性,两组经统计学比较,差异有统计学意义(P＜0.01).结论 EBV、MP病毒感染和维生素D缺乏,是造成小儿反复呼吸道感染的重要因素,反复呼吸道感染患儿应注意EBV、MP感染及维生素D缺乏的诊治,防止继发疾病的发生.     

Neuromeningeal enterovirus infections in Tunisia: epidemiology, clinical presentation, and outcome of 26 pediatric cases

Non-polio enteroviruses are the most common identified cause of viral neuromeningeal infections following the introduction of the mumps and polio vaccines. OBJECTIVE: The aim of this study was to describe the epidemiology, clinical presentation, and the outcome of enteroviral infections of the CNS. METHOD AND PATIENTS: We performed a prospective study on 41 children admitted for viral neuromeningeal infections in the pediatric department of Monastir between December 2001 and November 2002. Enteroviruses were detected from cerebrospinal fluid by RT-PCR. RESULTS: This study showed that enteroviruses were responsible for 63.4% of the infections. The mean age of patients was 6.1 years. Aseptic meningitis was diagnosed in 14 cases and encephalitis in 10. The most frequent symptom was fever (61.5%), followed by seizures (42.3%), and confusion (23%). On follow-up, all patients with meningitis had recovered without sequels. Neurological complications in patients with encephalitis were epilepsy (3 cases), cerebral palsy (2 cases), and mental retardation (1 case). CONCLUSION: This study confirmed that enteroviruses were the most common cause of viral infections of the CNS. Common use of RT-PCR can have a significant impact on the outcome of patients with enterovirus infections.     

Immunological status to Epstein-Barr virus and cytomegalovirus in patients with genital condylomata

Serological patterns against Epstein-Barr virus (EBV) and Cytomegalovirus (CMV) were determined in patients with genital condylomata (GC). The Ig G antibody values to EB-induced virus capsidic antigens (VCA), early antigens (EA) and Ig M to VCA were significantly higher in the study group than in the controls. Moreover, the concomitant presence of EBV-Ig G anti-VCA ≧ 1/320, EBV-Ig G anti-EA ≧ 1/20 and EBV-Ig M anti VCA ? 1/20 was observed in 13 serum samples of genital condylomata patients, while, in only 2 serum samples of the healthy controls, the same serological pattern was present. The distribution of antibody values to CMV-induced LA, EA and IEA showed a significantly increased prevalence in the study group in comparison with the controls: the concomitant presence of antibody with a titre ≧ 1/320 for CMV-LA, ≧ 1/20 for CMV-EA and ≧ 1/20 for CMV-IEA was observed in I5 serum samples of GC patients and in only 3 serum samples of the control group. Our results suggest that the active or recent EBV and CMV infections we observed in genital condylomata patients may be a consequence of impaired immunity in these patients, but it does not exclude a possible role of EBV and CMV in perpetuating human papilloma virus-induced cell proliferation.     

Seroprevalence of Bartonella henselae and Bartonella quintana infections in Poland in 1998-2001

Bartonella henselae and Bartonella quintana infections result in illnesses with symptoms of severity ranging from mild lymphadenopathy (CSD) to systemic disease. The aim of the study was to estimate a prevalence of B. henselae and B. quintana infections in human in Poland. Serum samples collected from 265 patients in 1998-2001 were tested for the presence of antibodies specific to B. henselae and B. quintana. Levels of serum IgM and IgG antibodies to Bartonella henselae and Bartonella quintana were measured with indirect microimmunofluorescence test (MRL Diagnostic, USA). Cats' sera were assessed with indirect microimmunofluorescence test (MRL Diagnostic, USA) and goat immune serum anti-cat IgG FITC conjugate (Sigma, USA). Bartonella henselae specific antibodies were detected in 146 (57.0%) patients with lymphadenopathy. From that number 11.3% have shown specific Bartonella henselae IgM serum antibodies. Bartonella quintana infection was detected with serological methods in 4 patients. It has been found that CSD is a seasonal infection, with most cases occurring in autumn. Most cases of the disease have been recognized in children 8-16 years old. Most of CSD cases (30.1%) were detected in Mazowieckie voivodeship. There were no cases of CSD in Pomorskie, Podkarpackie, Lubuskie and Opolskie voivodeship. The seroprevalence of Bartonella sp. infections in cats was estimated on 86% (31/36). The highest titer of specific Bartonella henselae antibodies detected in cats was 1024. The number of detected Bartonella henselae infections in Poland is very low. It is very probable that the number of cases is underestimated in our country. Cat scratch disease is the most frequently clinically and serologically identified bartonellosis.     

Microbial study of meningitis and encephalitis cases

Meningitis and/or encephalitis can pose a serious public health problem especially during outbreaks. A rapid and accurate diagnosis is important for effective earlier treatment. This study aimed to identify the possible microbial causes of meningitis and/or encephalitis cases. CSF and serum samples were collected from 322 patients who had signs and symptoms suggestive of meningitis and/or encephalitis. Out of 250 cases with confirmed clinical diagnosis, 83 (33.2%) were definitely diagnosed as bacterial meningitis and/or encephalitis cases (by using CSF culture, biochemical tests, latex agglutination test, and CSF stain), 17 (6.8%) were definitely diagnosed as having viral causes ( by viral isolation on tissue culture, PCR and ELISA), and one (0.4%) was diagnosed as fungal meningitis case (by India ink stain, culture, and biochemical tests). Also, there was one encephalitis case with positive serum ELISA IgM antibodies against Sandfly scilian virus. N. meningitidis, S. pneumonia and M. tuberculosis were the most frequently detected bacterial agents, while Enteroviruses, herpes simplex viruses and varicella zoster viruses were the most common viral agents encountered. Further studies are needed to assess the role of different microbial agents in CNS infections and their effective methods of diagnosis.