Enteroviral meningitis in children: Clinical and laboratory features with and without pleocytosis

Abstract

Background Enteroviruses (EV) are most common causes of the etiologically known aseptic meningitis in children. EV can be detected with polymerase chain reaction (PCR) in cerebrospinal fluid (CSF) samples. We aimed to evaluate the clinical and laboratory characteristics of children diagnosed with PCR-confirmed EV meningitis in CSF samples.

Patients Patients aged 1 month to 17 years who underwent lumbar puncture (LP) with suspected meningitis and had CSF viral PCR and culture results between September 2012 and January 2021 at a tertiary care hospital in Turkey were included.

Methods Patients with no virus detected in CSF samples by PCR was comprised PCR-negative group. The EV PCR-positive patients were divided into two groups based on CSF pleocytosis as enteroviral meningitis (EVM) with CSF pleocytosis and EVM without CSF pleocytosis, and compared in terms of clinical and laboratory features.

Results 78 (38.2%) were EV PCR-positive, and 126 (61.8%) were PCR-negative. Pleocytosis was detected in 55 (70.5%) EV PCR-positive patients and 94 (74.6%) of PCR-negative patients. Convulsion was significantly frequent (p=0.017) in EV PCR-positive patients with no pleocytosis. Protein and lactate concentrations in CSF were significantly higher in EV PCR-positive patients with pleocytosis (p=0.048, p=0.001, respectively). Median hospital stay was significantly longer in PCR-negative group (p<0.001).

Conclusion Diagnosing EVM with PCR prevents long-term hospitalization, unnecessary antibiotic use and healthcare-related complications.

Zusammenfassung

Hintergrund Enteroviren (EV) sind die häufigsten Ursachen der ätiologisch bekannten aseptischen Meningitis bei Kindern. EV kann mit der Polymerase-Kettenreaktion (PK) in Proben der zerebrospinale flüssigkeit (ZF) nachgewiesen werden. Unser Ziel war es, die klinischen und Labormerkmale von Kindern, bei denen eine PK-bestätigte EV-Meningitis in Liquorproben diagnostiziert wurde, zu bewerten.

Patienten Eingeschlossen wurden Patienten im Alter von 1 Monat bis 17 Jahren, bei denen zwischen September 2012 und Januar 2021 in einem Krankenhaus der Tertiärversorgung in der Türkei eine Lumbalpunktion (LP) mit Verdacht auf Meningitis durchgeführt wurde und bei denen zwischen September 2012 und Januar 2021 Ergebnisse einer CSF-Virus-PCR und -Kultur vorlagen.

Methoden Patienten, bei denen kein Virus in ZF-Proben durch PK nachgewiesen wurde, gehörten zur PK-negativen Gruppe. Die EV-PK-positiven Patienten wurden basierend auf der Liquor-Pleozytose als enterovirale Meningitis (EVM) mit Liquor-Pleozytose und EVM ohne Liquor-Pleozytose in zwei Gruppen eingeteilt und hinsichtlich klinischer und Labormerkmale verglichen.

Ergebnisse 78 (38,2%) waren EV-PK-positiv und 126 (61,8%) waren PK-negativ. Pleozytose wurde bei 55 (70,5%) EV-PK-positiven Patienten und 94 (74,6%) der PCR-negativen Patienten festgestellt. Krampfanfälle waren bei EV-PK-positiven Patienten ohne Pleozytose signifikant häufig (p=0,017). Die Protein- und Laktatkonzentrationen im Liquor waren bei EV-PK-positiven Patienten mit Pleozytose signifikant höher (p=0,048 bzw. p=0,001). Der mittlere Krankenhausaufenthalt war in der PK-negativen Gruppe signifikant länger (p<0,001).

Schlussfolgerung Die Diagnose von EVM mit PK verhindert einen langfristigen Krankenhausaufenthalt, unnötigen Antibiotikaeinsatz und behandlungsbedingte Komplikationen.

Keywords

aseptic menengitidis - children - enterovirus - polymerase chain reaction

Schlüsselwörter

Aseptische Meningitis - Kinder - Enterovirus - Polymerase Kettenreaktion

Publikationsverlauf

Artikel online veröffentlicht:
02. August 2024

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