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Postinfectious hydrocephalus (PIH), which often follows neonatal sepsis, is the most common cause of pediatric hydrocephalus worldwide, yet the microbial pathogens underlying this disease remain to be elucidated. Characterization of the microbial agents causing PIH would enable a shift from surgical palliation of cerebrospinal fluid (CSF) accumulation to prevention of the disease. Here, we examined blood and CSF samples collected from 100 consecutive infant cases of PIH and control cases comprising infants with non-postinfectious hydrocephalus in Uganda. Genomic sequencing of samples was undertaken to test for bacterial, fungal, and parasitic DNA; DNA and RNA sequencing was used to identify viruses; and bacterial culture recovery was used to identify potential causative organisms. We found that infection with the bacterium Paenibacillus, together with frequent cytomegalovirus (CMV) coinfection, was associated with PIH in our infant cohort. Assembly of the genome of a facultative anaerobic bacterial isolate recovered from cultures of CSF samples from PIH cases identified a strain of Paenibacillus thiaminolyticus. This strain, designated Mbale, was lethal when injected into mice in contrast to the benign reference Paenibacillus strain. These findings show that an unbiased pan-microbial approach enabled characterization of Paenibacillus in CSF samples from PIH cases, and point toward a pathway of more optimal treatment and prevention for PIH and other proximate neonatal infections.

We recently found that male sex, large family size, urinary incontinence and hydrocephalus were all associated with poorer self-reported quality of life (QOL) among 62 children aged 10–14 with spina bifida from Eastern Uganda.1 A limitation of this study was the absence of corresponding QOL scores for unaffected Ugandan children. We therefore conducted a survey to establish reference values for self-reported QOL among healthy Ugandan schoolchildren aged 10–14. A total of 141 healthy schoolchildren from 12 schools in Mbale district participated in a short interview to ascertain ‘health related quality of life’ using the objective Health Utilities Index (HUI3) tool,2 and a subjective measure of QOL using a visual analogue scale (VAS).3 Children were asked a single question, ‘how happy is your life?’ The interviewer indicated the 0 end of the scale (with a sad face pictured) representing ‘very bad’ and the 10 end of the scale (with a smiling face) representing ‘very good’; the child was asked to …