The hidden burden of viral meningitis in ethiopia: Etiology and clinical outcomes
6 affiliations
- 1Department of Medical Laboratory Science, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia.
- 2Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
- 3Department of Medical Laboratory Science, College of Health Science, Arsi University, Asella, Ethiopia.
- 4Department of Medical Laboratory Science, College of Health Science, Madda Walabu University, Robe, Ethiopia.
- 5Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
- 6College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
Abstract
Background: Viral meningitis remains a significant global public health problem, particularly in resource-limited settings where the diagnosis of viral etiology is mainly based on clinical assessment. This study aimed to identify the common viral etiologies of meningitis, describe their associated clinical features, and assess patient outcomes among individuals suspected of meningitis without evidence of bacterial meningitis. Methods: We conducted a multicenter study involving 430 patients clinically suspected of meningitis. Clinical data and cerebrospinal fluid samples (CSF) were collected following standard procedures. Viral nucleic acids were extracted from CSF specimens. Complementary DNA was prepared from viral RNA using reverse transcription. Viral nucleic acids were amplified and detected using qualitative conventional polymerase chain reactions. Patient outcomes were evaluated using the Glasgow Outcome Scale (GOS). Bivariate and multivariable logistic regression analyses were used to identify factors associated with unfavorable patient outcomes, with statistical significance set at a p-value < 0.05 at a 95% confidence level. Results: The prevalence of viral meningitis was 52.8% (227/430). Enteroviruses were the most common, 47.9% (206/430), followed by herpes simplex virus-1, 2.8% (12/430), herpes simplex virus-2, 1.4% (6/430), and Epstein-Barr virus, 0.7% (3/430). Overall, 6.7% (29/430) of study participants experienced unfavorable outcomes (GOS = 1–4). Factors independently associated with unfavorable outcomes included sex (AOR = 2.684, 95% CI = 1.177–6.119), duration from disease onset to hospital visit (AOR = 1.433, 95% CI = 1.043–1.967), and history of antibiotic intake before hospital visit (AOR = 2.784, 95% CI = 1.270–6.104). Conclusions: In this predominantly pediatric study, enteroviruses are the leading cause of viral meningitis in Ethiopia. Most study participants experienced favorable outcomes. Unfavorable outcomes were independently associated with sex, duration from disease onset to hospital visit, and history of antibiotic use before hospital visit. Further identification and characterization of Enteroviruses are warranted.
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BibTeX
@article{mesele2026hidden,
title = {{The hidden burden of viral meningitis in ethiopia: Etiology and clinical outcomes}},
author = {Derso Wale Mesele and Lema Ayele and Jemal Aman and Dawit Hailu Alemayehu and Ashenafi Alemu and Aschalew Gelaw and Yared Merid and Adane Mihret and Andargachew Mulu and Getachew Tesfaye Beyene},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0361291},
url = {https://doi.org/10.1371/journal.pone.0361291},
note = {CC BY},
}
RIS
TY - JOUR
TI - The hidden burden of viral meningitis in ethiopia: Etiology and clinical outcomes
AU - Derso Wale Mesele
AU - Lema Ayele
AU - Jemal Aman
AU - Dawit Hailu Alemayehu
AU - Ashenafi Alemu
AU - Aschalew Gelaw
AU - Yared Merid
AU - Adane Mihret
AU - Andargachew Mulu
AU - Getachew Tesfaye Beyene
PY - 2026
DA - 2026/10/23
JO - PLOS One
DO - 10.1371/journal.pone.0361291
UR - https://doi.org/10.1371/journal.pone.0361291
AB - Background: Viral meningitis remains a significant global public health problem, particularly in resource-limited settings where the diagnosis of viral etiology is mainly based on clinical assessment. This study aimed to identify the common viral etiologies of meningitis, describe their associated clinical features, and assess patient outcomes among individuals suspected of meningitis without evidence of bacterial meningitis. Methods: We conducted a multicenter study involving 430 patients clinically suspected of meningitis. Clinical data and cerebrospinal fluid samples (CSF) were collected following standard procedures. Viral nucleic acids were extracted from CSF specimens. Complementary DNA was prepared from viral RNA using reverse transcription. Viral nucleic acids were amplified and detected using qualitative conventional polymerase chain reactions. Patient outcomes were evaluated using the Glasgow Outcome Scale (GOS). Bivariate and multivariable logistic regression analyses were used to identify factors associated with unfavorable patient outcomes, with statistical significance set at a p-value < 0.05 at a 95% confidence level. Results: The prevalence of viral meningitis was 52.8% (227/430). Enteroviruses were the most common, 47.9% (206/430), followed by herpes simplex virus-1, 2.8% (12/430), herpes simplex virus-2, 1.4% (6/430), and Epstein-Barr virus, 0.7% (3/430). Overall, 6.7% (29/430) of study participants experienced unfavorable outcomes (GOS = 1–4). Factors independently associated with unfavorable outcomes included sex (AOR = 2.684, 95% CI = 1.177–6.119), duration from disease onset to hospital visit (AOR = 1.433, 95% CI = 1.043–1.967), and history of antibiotic intake before hospital visit (AOR = 2.784, 95% CI = 1.270–6.104). Conclusions: In this predominantly pediatric study, enteroviruses are the leading cause of viral meningitis in Ethiopia. Most study participants experienced favorable outcomes. Unfavorable outcomes were independently associated with sex, duration from disease onset to hospital visit, and history of antibiotic use before hospital visit. Further identification and characterization of Enteroviruses are warranted.
SN - 1932-6203
ER -