Central nervous system virus infection in African children with cerebral malaria

Douglas G. Postels, Lawrence Osei-Tutu, Karl B. Seydel, Qian Xu, Chenxi Li, Terrie E. Taylor, Chandy C. John, Macpherson Mallewa, Tom Solomon, Tsiri Agbenyega, Daniel Ansong, Robert O. Opoka, Lillian M. Khan, Prashanth S. Ramachandran, Kristoffer E. Leon, Joseph L. DeRisi, Charles Langelier, Michael R. Wilson

Research output: Contribution to journalArticlepeer-review


We aimed to identify the contribution of central nervous system (CNS) viral coinfection to illness in African children with retinopathy-negative or retinopathy-positive cerebral malaria (CM). We collected cerebrospinal fluid (CSF) from 272 children with retinopathy-negative or retinopathy-positive CM and selected CSF from 111 of these children (38 retinopathy positive, 71 retinopathy negative, 2 retinopathy unknown) for analysis by metagenomic next-generation sequencing. We found CSF viral coinfections in 7/38 (18.4%) retinopathy-positive children and in 18/71 (25.4%) retinopathy-negative children. Excluding HIV-1, human herpesviruses (HHV) represented 61% of viruses identified. Excluding HIV-1, CNS viral coinfection was equally likely in children who were retinopathy positive and retinopathy negative (P = 0.1431). Neither mortality nor neurological morbidity was associated with the presence of virus (odds ratio [OR] = 0.276, 95% CI: 0.056–1.363). Retinopathy-negative children with a higher temperature, lower white blood cell count, or being dehydrated were more likely to have viral coinfection. Level of consciousness at admission was not associated with CNS viral coinfection in retinopathy-negative children. Viral CNS coinfection is unlikely to contribute to coma in children with CM. The herpesviruses other than herpes simplex virus may represent incidental bystanders in CM, reactivating during acute malaria infection.

Original languageEnglish (US)
Pages (from-to)200-205
Number of pages6
JournalAmerican Journal of Tropical Medicine and Hygiene
Issue number1
StatePublished - Jul 2020

ASJC Scopus subject areas

  • Parasitology
  • Virology
  • Infectious Diseases

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