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DOI: 10.48087/BJMS.2026.130314
Authors: Nora RIGHI1, Meriem DEBBABI1, Rihab FELLAH1, Mélissa DOUMANDJI1, Yahia Abdelmoumen MEKKI2, Bruno LINA2
Affiliations: 1- Faculty of Medicine, Batna, Algeria. 2-Virology Laboratory, Croix-Rousse Hospital, Claude Bernard University Lyon 1, France.
Abstract
Over the past three decades, a clear neuroinvasive and neurotropic potential has been demonstrated for human coronaviruses (HCoVs), involving both primary and secondary central nervous system (CNS) involvement. The classical coronaviruses (229E, OC43, and NL63) are primarily responsible for upper and lower respiratory tract infections but have also been implicated in gastrointestinal and neurological diseases. Objective: To demonstrate the involvement of coronaviruses in encephalitis and meningoencephalitis prior to the SARS-CoV-2 pandemic, and to compare these findings with the neurological manifestations observed during COVID-19. Materials and Methods: To determine the etiological spectrum of encephalitis in Batna, Algeria, we conducted a prospective study using a broad diagnostic approach from April 2012 to August 2015. We adopted a case definition consistent with those used in previous studies, encompassing acute cerebral dysfunction with signs of inflammation, as well as cases presenting with meningeal inflammation and an associated encephalitic component (meningo-encephalitis). Patients were recruited from three departments — intensive care, infectious diseases, and pediatrics — and data were collected using a standardized case report form. The study aimed to identify etiological agents through a standardized diagnostic procedure and to describe the epidemiological, clinical, and biological characteristics, as well as outcomes associated with the different causes. Results: Using a comprehensive diagnostic approach, over 30 pathogens were tested in blood and cerebrospinal fluid (CSF). Among the 141 patients with acute infectious encephalitis, a viral etiology was established in 73 (51.8%), including 18 cases involving coronaviruses, of whom 4 had no coinfection. The median age was 20 years (range: 0–45), with immunosuppression present in 16.7% of cases. Sudden onset was observed in 38.9% of patients, neck stiffness in 38.9%, and a Glasgow Coma Scale score below 8 in 22.2%. Respiratory and hepatic involvement were each observed in 27.8% of patients. Pleocytosis was noted in 77.8% of cases, with hyperalbuminorachia in 55.6%. Respiratory viral coinfection was detected in 11.1%. The median duration of hospitalization was 19.5 days (range: 1–874), with a mortality rate of 5.6%. Conclusion: The neurological involvement of coronaviruses remains to be fully elucidated. Nonetheless, coronaviriform particles have been observed in brain tissue sections, and coronaviruses have been isolated from patients with multiple sclerosis (MS). Moreover, anti-coronavirus antibodies have frequently been detected at high titers in the CSF of MS patients.
Keywords: Encephalitis, Meningoencephalitis, Respiratory Involvement, Coinfections.