Post-Infectious Hydrocephalus in Ugandan Children Linked to Bacteria-Virus Combination

An international team of researchers has made a discovery of new bacteria and a common virus that may be causing infection-induced hydrocephalus in Uganda.

The doctors at CURE Children's Hospital of Uganda saw more than a thousand infants with infection-caused hydrocephalus when they visited Uganda thirteen years ago. Unfortunately, they were not able to culture anything in the laboratory during that time. Now, they have found over 8,000 children in one small Ugandan hospital who are suffering from the same condition.

Edith Mbabazi-Kabachelor, director of research, CURE Children's Hospital of Uganda, mentioned that untreated hydrocephalus among children less than two years of age would result in a continuous increase in head size that can cause further brain damage. This can cause severe cognitive and physical disability or end in the majority of these children die. 

Steven J. Schiff, a neurosurgeon at Pennsylvania State University, together with his team may have studied this problem for more than a decade, but they only tried a different approach during the last five years.

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The U.S. National Institutes of Health backed this 5-year study in Uganda. Through utilizing advanced genomic techniques, the team was able to uncover the major bacterial and viral causes of these infections. This was reported in Science Translational Medicine.

The researchers used DNA and RNA sequencing techniques to identify the organism behind this disease. They studied both the blood and cerebrospinal fluid (CSF) sample from a hundred post-infectious hydrocephalus and non-post-infectious cases infants in Uganda; all of them were under three months old.

Bacteria and Virus Combo

They have found a dominating bacteria, a previously unidentified strain of Paenibacillus thiaminolyticus in the samples. This bacteria is now named Mbale after the city where the CURE Children's Hospital is located.

The initial link between hydrocephalus and Paenibacillus was made through high-throughput sequencing, which allows the sequencing of more than one DNA molecule at the same time, and PCR analysis, which can multiply existing DNA samples to make them easier to analyze and identify. This was done at the Center for Infection and Immunity in the Mailman School of Public Health at Columbia University, a renowned center led by W. Ian Lipkin.

Schiff was not satisfied with finding the proposed bacterial cause of the problem, reasoning that other diseases are usually composed of both a bacterial and viral component.

This led the team to look for viral, fungal, and parasitic genetic material. Upon doing so, they were able to find cytomegalovirus (CMV) in the cerebrospinal fluid of babies with post-infection hydrocephalus, but it was absent in other hydrocephalus patients.

While the researchers believe they have found the cause of these infections, they are still unsure as to how the babies encountered this new bacteria as it may be soil- or water-borne. Schiff admitted that further research is needed to pinpoint the bacterial source as they cannot be certain if this particular bacterial virus combination exists outside this area of Uganda.

Hydrocephalus

Hydrocephalus is the abnormal buildup of cerebrospinal fluid in the brain cavities, and the most common childhood neurosurgical condition affecting the population in Uganda, according to Mbabazi-Kabachelor. 

Because it is still unknown whether this bacteria-virus combination is also present in similar infections in other regions of the world, proper prevention and care within an economic framework can help optimize the use of resources to be a better approach towards the health of these patients. 

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